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Reduced ejaculate specficially after Cyber knife

alb1208
Posts: 7
Joined: Jan 2012

I'm 46 and finshed 8 weeks of CK treatment 2 years ago. I'm doing ok as far my PSA (I finally got under 2)  but have experienced ED and reduction in ejaculate.  I anticipated both but thought I'd be the exception to the rule. In fact, I was some consumed with these issues that I went against popular opinion of having surgery as opposed to radiation. My question is simple...is there any product out there that can actually increase ejaculate? I see ads but they are seem to be scams. Has anyone tried anything that works? I know this should be the least of my concerns and that men who underwent surgery have no ejaculate at all but it's still important to me. Any advice would be appreciated. Thanks in advance. ALB

VascodaGama's picture
VascodaGama
Posts: 1728
Joined: Nov 2010

ALB

I have posted here before a thread about the 6 years results from CK treatments commenting on the benefits and troubles. In fact CK and IMRT are prune to similar outcomes in terms of the side effects. These tend to be short lived in younger patients but older guys or the ones with previous problems (already existing urinary or sexual dysfunctions before radiation) do not so well or get worse after the treatment.

I do not know much about your case but the condition could be due to the drugs you are taking or took before. Alpha blockers, which are part of the recommendations from our radiotherapists or are included in the treatment protocol, are known to have side effects that could lead to the problem of less fluid in ejaculation. These drugs do their job by relaxing the muscles in the prostate and bladder, affecting directly the sphincter contractions. Some guys experience Retrograde Ejaculation that is when the fluid (or part of it) to be ejaculated via the urethra is redirected to the bladder. (Normally, the bladder sphincter contracts and the whole ejaculate goes out through the urethra).

The typical blockers are; Flomax (tamsulosin), Rapaflo (silodosin) and Hytrin (terazosin) but there are many others. Are you taking any of them?

You may inquire at the CK forum dedicated solo to CK patients;

http://www.cyberknife.com/Forum.aspx

Best,

VGama

Swingshiftworker
Posts: 695
Joined: Mar 2010

I had CK in Sep 2010.  I did not experience any ED or any other side effects and my cancer is in remission.

However, I did expereince a gradual reduction (but not entire elimination) of ejaculate. The decrease in ejaculate is a normal result of radiation treatment of the prostate.  What is happening is actually called "retrograde ejaculation" which is the passage of semen into the bladder instead of thru the urethra from the testes because of the damage that was done to the prostate cells following treatment.  I do not believe that there is anyway to restore your ejaculate following CK or other radiation treatments.

Here's a very succint statement of the effect of radiation treatment on the prostate:

"Many patients are apparently under the impression that radiation therapy only affects the cancerous cells in their prostates and that the normal (“healthy”) cells will be unaffected by radiation therapy. This is simply not the case."

"Radiation of the prostate is designed to kill all cells in the gland if at all possible. It therefore has the same effect on the functioning of the prostate as radical surgery because (to all intents and purposes) there should be no living prostate tissue a year after the radiation is complete. The reason that there almost always is a small amount of living prostate tissue is that the radiation commonly does not, in fact, kill all of the normal prostate cells, which is also why PSA levels do rise slightly after first-line radiation therapy and don’t drop to undetectable levels. However, the amount of living prostate tissue that remains is normally far too small to permit normal ejaculatory function and normal orgasmic function."

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

I was somewhat concerned with the anticipated loss of ejaculate following CK treatment but I have found that it really doesn't matter.  I still orgasm and the sensation is the same.  There's just a little precum and ejaculate and much less mess than b4. OBTW, before I had CK, I refused to take FloMax because one of its side effects is/was retrograde ejaculation.  I take it now because I still have urinary frequency issues and the amount of ejaculate I have no longer matters following treatment w/CK.

 

will1946
Posts: 10
Joined: Dec 2010

Swingshiftworker:

I was stunned to read your quote that radiation (type unspecified) kills ALL the prostate gland. I went to prostate cancer info link, and indeed, they make that claim.

Can this possibly be true? I had surgery, myself, but did a lot of research beforehand, and never read or heard such a thing. A quick scan of my literature on the topic seems to indicate 

that only the cancer cells are killed, but that is not explicitely stated. Can anyone help me here?

Swingshiftworker
Posts: 695
Joined: Mar 2010

Radiation treatment cannot discriminate between cancerous and non-cancerous cells.  So, all of the cells affected by a sufficient amount of radiation (doesn't matter which method) kills the cell.  The object of prostate cancer radiation treatment is simply to kill all of the cells in the prostate, which in effect is the same a surgical removal of the prostate but without all of the risks of physical surgery.

So, with radiation, it's important to chose the method of treatment that is the most precise in delivering the radiation in order to avoid non-targeted damaging organs and tissue.  In the case of prostate cancer, the major problems caused by the inaccurate delivery of radiation are damage to the bladder, rectum, erectile tissue and the urethra.   The latter 2 problems can result in ED and incontinence and/or urethral blockage caused by scar tissuse growth in the urethra in response to damaging radiation which requires a TURP.

CyberKnife is the most accurate method of radiation delivery developed to date.  It can deliver radiation to the sub-mm level and can correct for both body and organ movement during treatment.  This is why CK seems to result in such a low rate of reported side effects, as compared with PBT, BT and IMRT.

 

 

 

VascodaGama's picture
VascodaGama
Posts: 1728
Joined: Nov 2010

Will

Radiation destroys the genetic code of cells. The target may be the cancer but when applied it does it indiscriminately, not just cancerous or benign prostatic cells are affected but any one cell in the “target line”. It is the DNA strand in these cells that will break; leading to cell’s death, induction of mutations or chromosome aberrations. Many cells that manage to repair the damage will continue duplicating into newer cells but no one can assure that these are totally benign. Cancer is microscopic tissue that cannot be seen in the open eye or by conventional image studies so that the whole practice of the radiotherapy is done sort of guessing. Doctors use past experiences or follow the guide lines of their associations.

The important aspect in the treatment is to decide on the amount of energy (ionizing radiation) needed to do the job with less collateral damage, avoiding reflective radiation. The isodose planning and the way to get those Grays deep inside into the area where cancer is thought to exists is an “artistic” work only achieved by excellent radiologists. In the decision process both the benefits and risks are counted for. The patient consensus is important in the decision so that he should be informed and involved in the discussions with the radiotherapy team;
http://www.radiologyinfo.org/en/careers/index.cfm?pg=rtcareer

A note on radiation; Ionizing radiation is radiation that carries enough energy to liberate electrons from atoms or molecules, thereby ionizing them. This process acts directly on the cellular component molecules (the nucleotides) resulting in breakage of the chemical bonds.

In any case, our DNA got the instructions to “repair” itself and does it with precision. Since DNA consists of a pair of complementary double strands, breaks of a single strand can be replaced fast. When both strands are damaged repair is more difficult and erroneous rejoining of broken ends may occur. These misrepairs leads to apoptosis but it may cause gene mutations or changes in the chromosome structure becoming cancerous. Mitosis continues either of a perfect benign cell or a permanently “defected” cell.

 

Here are some easy to understand reading material;

http://genetics.thetech.org/ask/ask402

http://www.cityu.edu.hk/ap/nru/BookAGRhapter7.pdf

http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/radiation/radiationtherapyprinciples/radiation-therapy-principles-types-of-radiation

 

Best,

 

VGama

 

will1946
Posts: 10
Joined: Dec 2010

Thanks for the responses, swingshiftworker and Vasco. My question now, is this: In salvage radiation treatment, after an RP, what will the radiation be killing, assuming that the prostatic bed is the suspected site of the newly detected PSA? It seems a little crude to just be nuking presumably useful tissue merely on the presumption that there may be some cancerous material in there.

Swingshiftworker
Posts: 695
Joined: Mar 2010

Sorry for the late reply.  Didn't see your post earlier.

Salvage radation therapy pinpoints locations where your doctor believes that the cancer is still growing, which usually lies in the remnants of the prostate bed.  It's not useable issue anymore; it's only what's left of the prostate that surgery could not remove.

It may be crude but better to try to kill what's left of the cancer than let it contine to grow unabated.

Hope the treatment works for you.  Good luck!

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