Are you, your spouse or someone you know faced with making a decision about prostate cancer treatment? Maybe watchful waiting is not for you. Perhaps time isn’t on your side because you’re not even 60 years old or the cancer is getting worse. But you’re nervous—maybe even “freaked out”—about starting radiation therapy because you know that erectile dysfunction (ED) is one of its main side effects. And ED can last forever.

When the choice of watchful waiting is iffy and you’re asked to consider radiation therapy, you will likely be given two options—external beam radiation therapy (EBRT), in which a beam or several beams of high-energy x-rays are shot into a tumor, or brachytherapy, in which tiny radioactive “seeds” are placed in the prostate near the tumor.

Both treatments are effective—and they’ve both been linked to ED. But a recent study has investigated, more precisely than before, what the risk of ED with one of these treatments actually is, and the results will come as a relief to many men and their loved ones.

Researchers spent 14 years following 542 patients who received permanent prostate brachytherapy—a type of brachytherapy in which implanted “seeds” slowly release radiation, targeting where it’s needed in the prostate and sparing the healthy surrounding tissue. The patients filled out a simplified version of a questionnaire called the International Index of Erectile Function before receiving brachytherapy and then many times over a period of years. The questionnaire gauges presence and severity of ED.


Frankly, the incidence of ED among patients before they went in for brachytherapy was pretty high, so the true impact of radiotherapy or brachytherapy on emergence of ED might not be as great as we think it is. Only 21%—or 116 of the 542 patients—had no ED and full sexual function before brachytherapy. But how many of the men who were fully functional (no ED) before treatment were still fully functional five years after brachytherapy? Among men younger than 60, it was 57%…and among men age 60 or older, it was 35%. You might think that’s not such great shakes, but when you consider that maintenance of sexual function after the other therapy, EBRT, has been reported to be as low as 32%, the picture changes.

And if you look at all the men who had at least “satisfactory” sexual function before treatment—that is, they were able to achieve and maintain an erection during sexual intercourse, even if the erection was sometimes suboptimal—the case for brachytherapy gets even stronger. In that group, 78% of the younger men and 65% of the older men had full or at least satisfactory sexual function five years after brachytherapy. Those results are very heartening!

It’s such a shame when treatment gets rid of prostate cancer but leaves men unable to fully enjoy their intimate relationships. So if you are presented with some difficult decisions about prostate cancer therapy, and it seems like you’re being asked to choose between life and quality of life, be sure to thoroughly explore with your doctors the question of whether brachytherapy is an option for you. The outcomes in terms of cancer remediation are excellent—and you might be preserving a great deal of “quality” in your life!