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Brachytherapy, a form of radiation therapy, is one of a handful of treatment options available to men suffering from prostate cancer.
Minimally invasive, it involves the implantation of radioactive “seeds” in or near the prostate gland that deliver continuous radiation to the target area over weeks, months, or even longer.
When compared with two other common treatment methods — prostatectomy or external beam radiation — brachytherapy is less threatening to erectile function and has become the treatment of choice for many oncologists specializing in the treatment of prostate cancer.
In an April 2014 presentation before the ESTRO 33 congress, a researcher reported that permanent brachytherapy preserves erectile function in roughly 50 percent of patients with prostate cancer. ESTRO is the acronym for the European Society for Radiotherapy and Oncology
It’s a Targeted Therapy
The primary advantage of brachytherapy is its ability to deliver a high dose of radiotherapy to the tumor while exposing adjacent healthy tissue to only very minimal levels of radiation. By contrast, external beam radiation is less targeted and causes ED in up to 68 percent of prostate cancer patients who receive this form of treatment.
Renee Oismuller, M.D., of Vienna’s SMZ-Ost Donauspital told ESTRO 33 attendees that brachytherapy alone is at least as effective as other established treatments for localized prostate cancers of low to intermediate risk.
“In addition to allowing the preservation of erectile function in half the men we studied,” said Oismuller, “it has the advantage of involving a short hospitalization of one to two days.” This short hospitalization is a benefit to both patients and health care systems, she said. By contrast, average hospital stays of four to five days are usually required for patients who undergo surgical removal of the entire prostate gland.
Study Tracked 529 Patients
According to a report posted at ScienceDaily.com, Oismuller’s research focused on erectile function in 529 prostate cancer patients between the ages of 45 and 84 with a median age of 67.4 years. All patients in the study received permanent brachytherapy implants between July 1999 and October 2013.
To gauge their erectile function after brachytherapy, all patients were required to complete questionnaires detailing their erectile status before the procedure, one month after treatment, and then every three months for the first two years. After the first two years, patients were asked to complete the questionnaires every six months up to five years and then only once a year after five years.
At two years after treatment, 46.3 percent of the brachytherapy implant patients reported satisfactory erectile function, a figure that grew to 51.4 percent at five years after the procedure.
It’s Not for All Prostate Cancer Patients
As previously noted, brachytherapy is recommended primarily for prostate cancers that are localized and determined to be of low to intermediate risk and thus is not an option for those whose cancers have spread beyond the prostate gland. However, for those for who are appropriate candidates for the procedure, Oismuller recommends that doctors make patients aware of this option and its benefits.
“I believe that it is our duty to inform all patients about all the treatment options available and perhaps to emphasize the advantages of brachytherapy implants to those who are sexually active,” said Oismuller.
In yet another presentation at ESTRO 33, Irish radiation therapist Carla O’Connell of Dublin’s Trinity College said doctors are often remiss in their obligation to discuss the implications of prostate cancer treatments on sexual function. She presented the results of a survey among Irish radiation therapists about what, if any, information about ED was given to patients in their care. The survey also looked at how — if at all — this information was provided and how comfortable therapists were in discussing matters of sexuality.
Many Therapists Duck the Issue
“We found that a large proportion of therapists either did not address ED during discussion with patients about their disease,” said O’Connell, “or only mentioned it if the patient raised the issue first.” In many cases, she said, the survey indicated that neither therapist nor patient felt comfortable enough to broach the topic. “A lack of time and the perception that patients do not expect radiation therapists to ask about sexual matters were the biggest barriers to addressing the problems of ED that we found,” she said.
To ensure that patients are as fully informed about the possible impact of radiotherapy on erectile function, O’Connell and her coauthors on the study recommend measures that can help fulfill that goal. They call for additional training in the various approaches that can be utilized in discussing and assessing radiotherapy’s potential sexual side effects. They also recommend the establishment of guidelines that clearly identify those responsible for such discussions and at what stage in treatment the discussions should take place.
Many Patients Go Uninformed
The survey clearly revealed that among the patients of therapists who responded, many are not getting sufficient information about treatment-related side effects that could profoundly affect long-term sexual function.
According to O’Connell, the Trinity College survey showed that responsibilities for discussing potential sexual side effects of radiotherapy are currently being shared between radiation therapists, nurses, and radiation oncologists. However, there were no clear-cut guidelines as to which of these professionals should broach the topic with the patient.
O’Connell said “it would be interesting to follow up this study with a survey that ascertained radiation oncologists’ role in ED education; for example, whether they currently discuss the issue at an early stage in patient treatment.” She also said she would like to see whether training in the discussion of sexual matters might help radiation therapists “feel more confident in their ability to do so.”
Also Used in Penile Cancer
While probably more widely known as a treatment for localized prostate cancer, brachytherapy is an increasingly popular alternative to surgery in men with certain forms of penile cancer.
At the May 2017 congress of ESTRO, French researchers presented findings from what they said was the largest study to date of brachytherapy use in treating penile cancer. The study’s lead author is Alexandre Escande, M.D., a resident in radiation oncology at the Gustave Roussy Cancer Campus in Villejuif, a suburb of Paris.
According to an article posted at MedicalDaily.com, penile cancer is usually treated with surgery, which can be life-saving but often results in a loss of both sexual and urinary function. For the treatment of penile cancer, brachytherapy involves the placement of radioactive wires in or near the tumor. This form of treatment is appropriate only for men whose cancer has not yet spread into the corpora cavernosa, the twin cylinders of spongy erectile tissue inside the shaft of the penis.
An ‘Organ-Sparing Strategy’
In his presentation at ESTRO 2017, Escande said the study’s findings suggest “that brachytherapy is an adequate upfront, organ-sparing strategy, which is usually associated with only mild to moderate toxicities. Men still have a good body image, and also sexual and urinary function for the majority.”
Of the 201 penile cancer patients who underwent brachytherapy, 85 percent survived with their penises fully intact five years after the procedure. After five years, only 4 percent of the brachytherapy cohort had to have their penises removed because the cancer had recurred and spread.
Based on these results, said Escande, “brachytherapy is the treatment of choice for selected patients whose cancer has not spread into the sponge-like regions of the erectile tissue in the penis. . . . It is effective at controlling and eradicating the cancer and allows a high number of men to preserve their penises.”
Penile Cancer Relatively Rare
Relatively rare in North America and Europe, penile cancer accounts for less than 1 percent of all cancers diagnosed in U.S. men, according to the American Cancer Society.
Roughly 95 percent of all penile cancers develop from flat skin cells known as squamous cells. While squamous cell cancer can develop anywhere on the penis, it is diagnosed most often on the foreskin of uncircumcised men or on the glans of the penis of those who have been circumcised. It is a relatively slow growing cancer and can usually be cured if caught at an early stage.
For many men whose erectile function has been impaired because of cancer-related treatment, the oral ED drugs known as PDE5 inhibitors can help them at least temporarily regain relatively normal erectile function. Under current U.S. regulations, these drugs — Viagra, Cialis, Levitra, Staxyn, and Stendra — are available only by prescription.
You Can Buy Them Locally or Online
If you have a prescription for one of these drugs from your regular doctor or urologist, you can have it filled at your neighborhood pharmacy or opt instead to order it online from a reliable supplier such as eDrugstore.com. If you decide to go the latter route, you can fax the prescription or scan and email it along with your order to eDrugstore.
If you don’t have a doctor’s prescription and would prefer to avoid the added cost of an office visit, eDrugstore can arrange a complimentary online consultation with one of its team of licensed U.S. physicians. If you are found to be an appropriate candidate for one of the PDE5 inhibitors, based on your symptoms, medical history, and other medications you’re taking, a prescription will be authorized. To get started, click below to access eDrugstore’s Erection Problems page.
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