Product warning labels, like most things, change over time. Since the 1850s, the skull and crossbones on a bottle or package has been a clear message that something inside is poisonous. Today, the word “toxic” is widely used to cover all kinds of dangerous chemicals that contaminate our environment (“toxic waste”). We know that anything toxic has the potential to kill, and that characteristic is called toxicity.
Toxicity is a word that gets applied to many bad things. We talk about a toxic relationship, a toxic mix, a toxic state. It can be confusing, though, when the word is used in connection with something that’s supposed to save life. I came across a research abstract with the title “Patient-reported Sexual Toxicity After Radiation Therapy in Long-term Prostate Cancer Survivors.”[i] That got my attention. Not long ago, I wrote a blog on the need to be honest about ED after radiation (https://sperlingprostatecenter.com/telling-the-truth-about-post-radiation-sexual-problems/). I was gratified to see the September, 2015 publication of this abstract, despite the rather scary use of the term “toxicity” in connection with a prostate cancer treatment.
The study was published by a Swedish research group, not surprising given Sweden’s longstanding reputation for sexual openness. It involved 518 men who were treated with radiation, and 155 with no history of PCa (for reference) who were matched for age and residency. The study was conducted by administering questionnaires, in other words it was based on self-report. It covered 16 symptoms related to erectile function, libido (desire), orgasm and seminal fluid. Whether the men had beam radiation as a primary (first) treatment, as a salvage treatment (for failed prostatectomy) or a primary combination beam/brachytherapy, the questionnaire results were consistent. Radiation affected the men’s sex lives: “Not being sexually active was almost one and a half times as common in survivors as in reference men.”
To paraphrase, radiation can have a toxic effect on a man’s sexual relationship with himself and his partner. We also know that radiation scatter has an additional toxic side effect: it can increase the risk of secondary cancers of the bladder and bowel. To be sure, radiation therapy is an appropriate choice for many patients especially if they are not candidates for prostatectomy because of elderly age or co-existing medical conditions. In the interest of “informed consent,” patients considering radiation therapy deserve to be told about all of the possible implications of undergoing radiation.
[i] Olsson CE, Alsadius D, Pettersson N, Tucker SL et al. Patient-reported sexual toxicity after radiation therapy in long-term prostate cancer survivors. Br J Cancer. 2015 Sep 1;113(5):802-8. doi: 10.1038/bjc.2015.275. Epub 2015 Aug 4.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
