In preparing for prostate cancer treatment, I’ve decided on brachytherapy (“seeding”) . But I wonder what advantage this has over surgery and what side effects men with seeding experience?
RABBI ED’S ANSWER
Like you, In January 2007, soon after my prostate cancer diagnosis (PSA 6.6, Gleason 6), I briefly considered brachytherapy. But as I describe in my book Conquer Prostate Cancer, I soon learned that a patient’s exposure to radiation means he’ll continue being a source of radiation for 2-4 months.
I realized that this would force me keep me at a distance from my infant granddaughter. That was unacceptable emotionally, so I nixed brachytherapy and chose robotic surgery.
Brachtherapy involves inserting about 100 radioactive titanium pieces the size of rice, into the prostate via the perineum (the area between the scrotum), pin-cushion style. Some respondents who’ve selected brachytherapy assert they have had no major side effects and lead a normal sex life after such treatment.
According to my research this tends to be true for the short-term, though 7 to 12% experience incontinence. However, in the long term - meaning between 2 to 5 years after brachytherapy, there's a 50-50 chance that ED will set in due to the accumulative affect of radiation.
While most men are more likely to sustain erections for at least the first couple of years following radiation treatment, ejaculation is no longer possible for any of these treatment options.
Surgery has the same or worse odds of a man ending up with ED plus loss of ejaculatory capacity, even with nerve-sparing; though for about 70-90% of men that's offset by Viagra, a vacuum erection device, etc.
However, the advantage of surgery is that you can generally count on being "cured” and the removed prostate can be biopsied to retest for the Gleason score and to determine whether your prostate has negative or positive margins. If your margins are negative,this means you'll have a greater assurance of avoiding cancer recurrence after surgery than with radiotherapy. To be sure this is a a generalization.
Putting it differently brachytherapy’s post-treatment nadir (low point) leaves most men with a PSA of about .2, whereas surgery in most cases leaves a man’s PSA at a undecipherable level of .1 or less.
In general after seeding, external beam radiation, and surgery men can still orgasm, even without an erection or ejaculation. Solely on that basis these different treatment options may be a "draw". The fact that the side effects of each approach are comparable makes it that much harder for patients to decide which option is best.
Good luck regardless of the treatment you choose!