Cross-sectional analysis of sexual function after prostate brachytherapy

Objectives. To assess sexual function after prostate brachytherapy and compare outcomes in different age groups. Methods. This cross-sectional study consisted of 96 sexually active patients (mean age 64 years) who underwent iodine-125 seed implantation between 1997 and 2003 to treat early-stage prostate cancer (Stage T1-T2). Patients completed a questionnaire adapted from the validated Rand 36-item Health Survey and the University of California, Los Angeles, Prostate Cancer Index. Results. The median follow-up was 2.5 years (range 3 months to 6.2 years). The mean value for sexual function was 54.8. The mean score for erectile function was 55.0, and the mean score for the ability to reach orgasm was 54.0. No significant relationship was found between sexual function and time since treatment (P = 0.9897). Pain on orgasm was reported after brachytherapy by 38 patients (40%) and hematospermia by 16 patients (17%). A negative correlation was observed between pain on orgasm and time since treatment (P = 0.021), but no significant relationship was found between hematospermia and time since treatment (P = 0.427). A significant difference in sexual function was observed between patients younger than 60 years and patients older than 60 years (66.3 +/- 7.0 versus 47.7 +/- 7.2; P = 0.002). Conclusions. A large variation in sexual potency is present after brachytherapy with no significant relationship to the time since treatment. Age is an indicator of sexual function after brachytherapy, with younger patients experiencing less sexual dysfunction than older patients. Other aspects of sexual function (pain on orgasm, hematospermia) are also significant side effects of brachytherapy and must be considered in the treatment decision for low-risk prostate cancer.