by Trevor Pope

I received a diagnosis of prostate cancer ten years ago, and it was treated with brachytherapy. The treatment was a success and the outcome is that my cancer is cured. That is, if cancer is ever really completely cured? I do have some mild side effects of the brachytherapy treatment, but these are quite bearable, particularly when I consider the other possible outcomes.

If you are faced with the same diagnosis, and even considering treatment options, you may be feeling like a deer caught in the headlights. There may be a flood of information glaring down at you, having to make life changing decisions on treatment. Here’s more about my personal story.

Impact on sexual function and urination

I am fortunate not to have experienced any erectile disfunction and don’t have any other conditions that can cause it. Apparently, it can happen with brachytherapy, but the incidence is much lower than other treatment options. Erectile dysfunction can be caused by other conditions as well, so if you do experience it, the brachytherapy may not be to blame.

When I was young, I was pleased with “twice in one night.” I still am – but this now refers to how many times I have to get up to pee.

Ten years after brachytherapy, I am still on tamsulosin to ease urination difficulties, although these are not severe. It does help with emptying the bladder more fully, particularly at night. Tamsulosin is stated to have low side effects, but I did experience some “orgasmalgia” and “anejaculation”, which may have also been caused by the brachytherapy.

Brachytherapy sexual side effects: intermittent pain

Orgasmalgia refers to any pain that occurs at the time of orgasm. I experienced it intermittently as a burning sensation that seemed to be located around my prostate gland.

Anejaculation refers to “the pathological inability to ejaculate despite an erection in males, with (orgasmic) or without (anorgasmic) orgasm” (Wikipedia). This is different to retrograde ejaculation, where the semen is discharged backwards into the bladder because the bladder sphincter is not closing completely at the time. In anejaculation, the semen is generated and stored in the seminal vesicles, but is not completely discharged at orgasm. This can lead to some discomfort until the excess fluid dissipates. Teenage boys may experience this after heavy petting that did not lead to orgasm. The resulting ache is often described as “Blue balls” or “Lovers balls”.

Tamsulosin apparently, helps with orgasmalgia (burning sensation), but makes the anejaculation worse – I get to pick my poison. My urologist Kevin Fisher suggested I skip a tablet the day before sex, to allow the levels to drop. I did try this, but without conclusive results, as the symptoms I experience are somewhat intermittent anyway. The insert says the elimination half-life for tamsulosin is 9-13 hours, so I would have to wait at least a day.

This study of sexual function after brachytherapy provides an overall positive outlook and also suggests that tamsulosin drugs are implicated in the side effects I have experienced. Another article concludes that tamsulosin provides relief for pain associated with orgasm for men.

Overall satisfaction

These symptoms are intermittent, but can cause some discomfort. It helps to know what is causing them.

I suppose I also have to be realistic – many things don’t work as quite well as they did when I was younger. Perhaps I should be grateful that they work at all! I still have a happy sex life with my understanding wife, so please don’t let the possibility of these symptoms dictate your choice of treatment. They are minor compared to what can go wrong if you make a bad choice!

Aside from the above, I am pleased to report I have no other long-term issues related to the brachytherapy. We all have our health issues as we get older. In my case, none seem to be related to the treatment.