Of 270 sexually active men with localized prostate cancer treated with permanent 125I 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.
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).
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.