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Ejaculation after Brachytherapy

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Posted 7/23/2018 8:24 PM (GMT -5)
There is widespread misunderstanding that radiation does not kill healthy prostate cells. A small amount of healthy cells may survive. That explains ejaculation dries up in most cases after radiation treatment, particularly brachytherapy. See the following article:

https://prostatecancerinfolink.net/2013/04/01/anejaculation-is-the-norm-after-radiation-therapy-to-the-prostate/

In my case, I became completely dry within a year or so after brachytherapy. Current increase in PSA a year and half after cyberknife and ADT to treat extra-capsular mass is most likely coming from outside the prostate. My PSA was undetectable from 4/17 to 1/18. Then within a period of six months it increased to 0.9
Posted 7/23/2018 8:39 PM (GMT -5)
clickable version: /prostatecancerinfolink.net/2013/04/01/anejaculation-is-the-norm-after-radiation-therapy-to-the-prostate/

6 years post IMRT, I have very little ejaculate.

Andrew
Posted 7/23/2018 10:07 PM (GMT -5)
Loss of ejaculation is not the same as "killing healthy cells." One of the reasons Mike asked me to write about radiation issues for the infoLink was because he admitted to me that he really doesn't understand radiation. There are undoubtedly many healthy cells that survive radiation. In fact, most healthy cells can self-repair, but healthy cells that can't self-repair kill themselves (apoptosis) and are quickly replaced. Radiation relies on a "therapeutic ratio" -more cancer cells are killed than healthy cells.

Loss of ejaculate may arise for two reasons:

(1) Radiation dries up secretory cells (it doesn't kill them). We see this when people get radiation for head and neck cancers - the salivary glands stop secreting saliva. I like the way John T puts it - "the prostate becomes fallow."

(2) Scar tissue may plug up the entrance and exit of the seminal vesicles.

I know several guys who continue to produce ejaculate after radion - I was not one of them.

I do still have a prostate, which my urologist tells me feels completely healthy - it is about 20 cc, by his estimate.
Posted 7/26/2018 7:19 PM (GMT -5)
Still some there when I have not recently taken Rapaflo. But less than before.
Posted 7/26/2018 11:08 PM (GMT -5)
I too still have a prostate.

I vary between totally dry to about 20% of what I used to produce prior to the cancer.

My last radiation go around ended in Summer 2015.
Posted 7/27/2018 5:05 AM (GMT -5)
I also am dry after HDR BT.
Posted 7/27/2018 6:14 AM (GMT -5)
I produce maybe a third of the ejaculate I did pre-treatment.
Posted 7/27/2018 6:35 AM (GMT -5)
Reduced, but still about a third the amount prior to radiation.

As TA says, prostatic tissue remains, but it doesn’t continue to fully function as before radiation. Usually reduced ejaculate and reduced PSA expression. Look at TA’s signature showing the continued PSA of 0.1 post treatment. If his 20cc prostate had not been radiated we would expect it to express about 1.2 PSA. My prostate was estimated at 38cc so without radiation I would expect about 2.4 PSA, yet I continue to be undetectable. So the radiation does permanently affect the non-cancerous prostatic tissue and it’s offspring.
Posted 7/27/2018 7:16 AM (GMT -5)
Would it be wrong to state: "Radiation inhibits healthy prostate cells from producing normal amount of PSA"?
Posted 7/27/2018 11:30 AM (GMT -5)
I think that's a fair statement - But 'normal" doesn't mean ideal - a very healthy prostate (say, in a 25 yo man) should not be dumping any PSA into the serum. It is only because of pathology (eg., BPH, prostatitis, urinary retention, PCa) that PSA finds its way into the serum. PSA is supposed to stay in the prostate and semen. So cells that have been healed by RT may not dump PSA anymore.
Posted 7/27/2018 11:39 AM (GMT -5)
Another question: Why prostate cancer cells dump PSA into the serum?
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