Originally published 10/28/2015
In the good old days, medical record-keeping meant organizing and storing enormous amounts of hard copy patient files. Now, electronic health records (HER) and cloud storage afford researchers access to case files, all from the doctors’ viewpoints. This is valuable, but it doesn’t always reflect the whole story.
For example, a doctor who has treated a prostate cancer (PCa) patient with surgery or radiation may not know the degree to which his patient has erectile dysfunction (ED) as a result of the treatment. “Men are often embarrassed to disclose their sexual dysfunction. This may lead to sexual side effects related to PCa treatment remaining untreated, adding to their burden of disability,” write Röscher et al.[i]
Like the paper we wrote about in the original 2015 blog below, this 2022 publication points to the importance of obtaining the patient’s report of his own experience—but how to gain this? Busy doctors can’t chase down patients to learn if they’re silently suffering common treatment side effects like incontinence, ED, less penis length, orgasmic dysfunction, etc. Therefore, the use of standardized questionnaires may provide a platform for knowing how patients are doing after treatment.
The Röscher paper concludes, “Clinicians may be able to use the responses from a specific patient questionnaire as a starting point to discussing issues relating to the patient’s specific symptoms… “[ii] In turn, a doctor can offer interventions to reduce or eliminate symptoms, thus saving patients from potential worsening and further suffering.
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.”[iii] 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.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Röscher P, Sathiram R, Milios JE, van Wyk JM. Mapping the prevalence and use of questionnaires to detect the neglected sexual side effects after prostate cancer treatment: a scoping review. Syst Rev. 2022 Jan 3;11(1):2.
[ii] Ibid.
[iii] 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.
