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Post-SBRT Ejaculate Volume

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Posted 5/27/2021 12:41 PM (GMT -5)
It's been 2 years since SBRT after intermediate G7 diagnosis. Current PSA is 0.031 and both urinary and erectile function is good. However, ejaculate volume has continued to decrease to near zero. I know that the prostate was significantly radiated so that volume loss is understood but the seminal vesicles should have had only minimal exposure and I know that they have a significant contribution to the total volume. Or maybe it is more of a plumbing issue resulting from the treatment? It's not a retrograde issue as subsequent urine is clear. I did not do ADT. I have not been on Flomax for over a year and take a daily 5mg generic Cialis dose. Any fellow SBRTers out there with the similar issue (no ejaculate) or mainly just a reduction in volume? Thanks for any insight.
Posted 5/27/2021 1:44 PM (GMT -5)
I didn’t use SBRT, but had radiation with HDR brachytherapy and IMRT. The reduction or even loss of ejaculate is very common with radiation therapy. As you said, much less or even little of the functioning prostate remains so less ejaculate and PSA are two of the results. A main purpose of the prostate is to rapidly squeeze the fluids through the urethra causing ejaculation. With less functioning muscle and more radiation induced scar tissue the squeezing action is greatly diminished forcing less fluid through. I have never heard of anyone being treated for it and my urologist and radiation oncologist both told me it would happen.

Great PSA results and glad you are pretty much side effects free. Like you, diminished ejaculate is the only treatment side effect I have after more than 10 years. Of course the best treatment side effect is an undetectable PSA.
Posted 5/27/2021 1:46 PM (GMT -5)
As I got older my volume of ejaculate decreased and following SBRT it dropped to a very low level and it seems to drip late. It’s my understanding that the source maybe the Cowper’s gland whatever that is. In any event orgasm is still as pleasant as prior to treatment and at age 74 no complaints of urinary or sexual function. My wife says simply the wet spot on the bed is not as big as it used to be.
Posted 5/27/2021 2:01 PM (GMT -5)
Hi T. S. Why would you not want to irradiate the seminal vesicles with primary RT for intermediate risk? As some men learn after surgery (when both seminal vesicles are almost always removed), one's cancer may have spread to one or both. Imaging like MRI can hint at seminal vesicle invasion, but it is not conclusive. If you happen to have SVI and SBRT were to be limited exclusively to the prostate, you'd almost be guaranteed a recurrence. The same holds for nearby possibly positive lymph nodes and periprostatic fat in the case of extraprostatic extension.

Djin
Posted 5/27/2021 3:21 PM (GMT -5)
TS, I had LDR Brachy rather than SBRT but understand the results are generally the same, i.e. cure and lasting side effects pretty much limited to loss of ejaculate. Mine slowly disappeared and is now down to a trickle. O's are the same but the wet spot is tiny.

Jim
Posted 5/27/2021 4:08 PM (GMT -5)
Brother,

Me Too!

Prior to 45-sessions of IGRT (necessitated by 3 + 4 = 7), I erupted like Mt. Vesuvius - - I kid you not. Now, I can't even fill half-a-teaspoon.

My feelings? PSA was 8.7 when my no-holds-barred Texas Death Match versus PCa began. Now, it is 1.4 and plunging downward.

The ejaculate volume might be substantially less - - -

But I have my life back, sperm be darned!!!

NJ Fred
Posted 5/28/2021 5:45 PM (GMT -5)
I'm another Post Toastie SBRT patient. I was "just barely" G3+4, having almost all 3+3, one core 3+4. I am now 41/2 years out from my treatment. My ejaculate volume stayed "normal" for the first year or two, then it dropped drastically in volume. My current status is like Terry's Cellar. My ejaculate volume has dropped to maybe a drop, sometimes/often zero. When that drop does come along, it is always long after orgasm. It just seems to leak out a long time later. Not even enough to be annoying in one's clothing, just like a urine drip.

I've gotten over it. My PSA has gone from 5.69 pre-treatment, to 0.96 for the past two tests (every 6 months). I'm fine with it, and it is quite normal to have things dry up after radiation treatment. My RO is always surprised at how easily I've adjusted to it. For me, the choice was an easy one. Forego treatment, keep the mess, and let the PCa have its way. . . or torch the sucker and go dry. Still feels great, maybe even better than before.

Of course, at age 73, I had no intentions of adding to the family. . .
Posted 5/31/2021 9:52 AM (GMT -5)
EBRT and LD brachy here. The only thing that comes out now, after 2.5 years, is clear fluid. Nothing milky at all, but I still have a lot of it, so to speak.
Posted 5/31/2021 10:45 AM (GMT -5)
No matter what treatment you have for PCa, you're going to be sterile. Period. As a surgery patient, I had the immediate loss of ejaculate--but you know what? It doesn't matter. I'm still functional, and the O's are every bit as good--sometimes better--than before. And no mess at all. Which I think is overall a good thing.
Posted 5/31/2021 1:46 PM (GMT -5)
Actually surgery guarantees sterility as the necessary plumbing I’d physically disrupted. Men who are young enough to still be adding to their family are advised to bank some sperm before a RP. Young radiation men should be so advised as well, even though they will still have some prostate function it may make it tough to conceive based on lower volume of semen. As long as any some can be expressed, the man is technically sterile.

This isn’t an issue with most men as the most common ages for PCa to be diagnosed is well after child conceiving for most men. But if a strong 70 year old married to a much younger woman still wanted to procreate, then sperm harvesting before treatment would be advisable.
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