Ejaculatory function after permanent 125I prostate brachytherapy for localized prostate cancer.
OBJECTIVE
Ejaculatory function is an underreported aspect of male sexuality in men treated for prostate cancer. We conducted the first detailed analysis of ejaculatory function in patients treated with permanent (125)I prostate brachytherapy for localized prostate cancer.


METHODS
Of 270 sexually active men with localized prostate cancer treated with permanent (125)I prostate brachytherapy, 241 (89%), with a mean age of 65 years (range, 43-80), responded to a mailed questionnaire derived from the Male Sexual Health Questionnaire regarding ejaculatory function. Five aspects of ejaculatory function were examined: frequency, volume, dry ejaculation, pleasure, and pain.


RESULTS
Of the 241 sexually active men, 81.3% had conserved ejaculatory function after prostate brachytherapy; however, the number of patients with rare/absent ejaculatory function was double the pretreatment number (p < .0001). The latter finding was correlated with age (p < .001) and the preimplant International Index of Erectile Function score (p < .001). However, 84.9% of patients with maintained ejaculatory function after implantation reported a reduced volume of ejaculate compared with 26.9% before (p < .001), with dry ejaculation accounting for 18.7% of these cases. After treatment, 30.3% of the patients experienced painful ejaculation compared with 12.9% before (p = .0001), and this was associated with a greater number of implanted needles (p = .021) and the existence of painful ejaculation before implantation (p < .0001). After implantation, 10% of patients who continued to be sexually active experienced no orgasm compared with only 1% before treatment. in addition, more patients experienced late/difficult or weak orgasms (p = .001).


CONCLUSIONS
Most men treated with brachytherapy have conserved ejaculatory function after prostate brachytherapy. However, most of these men experience a reduction in volume and a deterioration in orgasm.
Department of Urology and Andrology, University Hospital, CHU Rangueil, Toulouse, France.
Eric
E
Huyghe
Martine
M
Delannes
Fabien
F
Wagner
Boris
B
Delaunay
Joe
J
Nohra
Matthieu
M
Thoulouzan
J Yeung
JY
Shut-Yee
Pierre
P
Plante
Michel
M
Soulie
Patrick
P
Thonneau
Jean Marc
JM
Bachaud
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects*; D004542:Ejaculation / Q000502:physiology / Q000528:radiation effects*; D006306:Health Surveys; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009948:Orgasm / Q000502:physiology / Q000528:radiation effects*; D010146:Pain / Q000503:physiopathology; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D007457:Iodine Radioisotopes