Radiation treatments for prostate cancer are used in many different forms, both beam radiation and seed implants:
- EBRT (External Beam Radiation Therapy
- IMRT (Intensity Modulated Radiation Therapy)
- 3D-CRT (3D Conformal Radiation Therapy)
- SBRT (Stereotactic Body Radiation Therapy)
- Proton beam
- Brachytherapy (radioactive seed implants, either permanent or a single treatment of high dose rate brachytherapy, or HDR)
Improvements have been made in radiation to try to limit the exposure to the area of disease and spare healthy tissue, but the fact is that all radiation has some scatter effect. The very word “radiation” conveys the radiant (spreading) nature of this treatment. Therefore, the neurovascular bundles (nerves and tiny blood vessels or NVB) that hug the prostate gland and control erectile function will inevitably have some exposure to radiation, however small.
Every man’s anatomy is different, and each type of radiation listed above will have a greater or lesser effect on the NVB system, so it’s not possible to predict which radiation patients may experience sexual problems after treatment, or when they will occur and how long they’ll last.
According to a recent article from UroToday, an internet source of urology news, post-radiation problems are more common than patients are told. According to the article, difficulties with “desire, arousal, orgasmic and sexual pain difficulties that arise after pelvic radiotherapy” are “less readily acknowledged by health professionals and patients alike…”[i] To address this situation, the article calls for broad honesty and awareness of the “sexual consequences” of pelvic radiation. Only in this way can better assessment and clinical management be made available to prostate cancer patients who experience diminished sexual performance and satisfaction after treatment.
Our Focal Laser Ablation (FLA) treatment has nearly zero risk of erectile or other sexual dysfunction. Almost all of our patients quickly return to baseline function. Even though not all patients will qualify for FLA, it is well worth being evaluated for this procedure by imaging with our powerful 3T multiparametric MRI scanning, and if necessary having an in-bore MRI-guided biopsy with a minimum number of needles targeted accurately into the suspicious area. The advantages of FLA include immediate, verifiable tumor destruction, ability to monitor success over time with imaging and biomarkers (no biopsy unless necessary), repeatability if needed, and keeping all future treatment options open. Radiation therapy does not offer any of these advantages:
- Its mechanism for eliminating cancer is not immediate
- The cancer cells that are gradually dying off are not verifiable by imaging or other means
- Success over time is monitored by PSA blood draws (rising PSA is assumed to mean treatment failure, followed by biopsy)
- It is not repeatable – there can be no additional radiation to the prostate bed
- Future treatment options are few (RP is difficult after radiation, and ablation by freezing or HIFU has a high side effect profile so most men are put on hormones which are not curative)
There are many men for whom prostate cancer radiation is their best choice; it is often recommended for men too old to undergo prostatectomy or who have preexisting conditions that would make surgery difficult, but who have 10+ years of life expectancy. However, younger healthy patients who are told they are candidates for all treatment options deserve to be informed about the actual risks of sexual side effects after radiation, just as the UroToday article recommends. Even if they are not candidates for focal therapy such as FLA, they might want to give careful consideration and perform as much online research as possible into the short- and long-term sexual side effects of each type of radiation before making a decision.