Brachytherapy Sexual Effects Defined
Erectile dysfunction risk is elevated, but the treatment preserves ejaculation in majority of cases.
One study showed that the proportion of patients with no or mild erectile dysfunction (ED) decreased from 87% before treatment to 55% afterwards. The other study—the first to focus on ejaculation after prostate brachytherapy—demonstrated that ejaculation is conserved in more than two thirds of men. Study findings were presented here at the 22nd European Association of Urology Congress.
Both studies, which were led by Eric Huyghe, MD, of CHU Rangueil in Toulouse, were conducted by the same French researchers and examined the same group of 316 men (mean age 66 years) who underwent permanent implantation of 125I seeds for localized prostate cancer. No patient received supplemental external beam radiation therapy, and 29% received adjuvant antiandrogen therapy for up to four months.
The researchers evaluated erectile function using the International Index of Erectile Function (IIEF-5) questionnaire. Of the 316 patients, 210 (66%) answered the questions about erection and 198 (63%) completed the items concerning ejaculation.
The erectile function study demonstrated that most of the men were sexually active before treatment, experiencing no or only mild erectile dysfunction (ED). More specifically, 81 (41%) patients had no ED, 53 (27%) had mild ED, 38 (19%) had mild-to-moderate ED, 11 (6%) had moderate ED, and 13 (7%) had severe ED. After treatment, 21 (13%) patients had no ED; 26 (16%) had mild, 46 (27%) mild-to-moderate, 24 (14%) moderate and 51 (30%) had severe ED. The median time to ED onset was eight months.
In the ejaculation study, which was presented by Joe Nohra, MD, also of CHU Rangueil, 179 (90%) of the 198 men who answered the relevant questions reported being able to ejaculate. After seed implantation, ejaculation was preserved in 138 men (70%), although 120 (55%) reported a decrease in semen volume and 34 men (17%) reported anomalies of ejaculation such as pain and hemospermia. The median time to appearance of these anomalies was four months (range 2-12 months).