Potency After Prostate Brachytherapy Hinges on Many Factors

Kate Johnson

April 07, 2014

VIENNA, Austria — Erectile dysfunction (ED) after prostate brachytherapy is largely predicted by pretreatment sexual function and age in addition to smoking status and comorbid conditions, such as diabetes and hypertension, according to new research presented here at the European Society for Radiotherapy and Oncology (ESTRO) 33 annual conference.

Of men younger than age 60 years who have full sexual function before treatment, about half will maintain it 5 years after brachytherapy, whereas among those with satisfactory pretreatment function, about a quarter will maintain it, said Renée Oismüller, MD, from SMZ-Ost Donauspital in Vienna, Austria. "I was pretty surprised with these results — they're pretty good," she told Medscape Medical News in an interview after her presentation.

The findings compare similarly to previous studies in this area, said session moderator Ann Henry, MD, a consultant at St James's Institute of Oncology in Leeds, United Kingdom.

"Brachytherapy is generally one of the better treatment options for maintaining sexual function and is considered to be as effective [for cancer treatment] as any of the other treatments — surgery or external-beam radiotherapy — for prostate cancer," Dr. Henry told Medscape Medical News. "This study adds to what is already known on this."

In a written statement, Professor Vincenzo Valentini, a radiation oncologist at the Policlinico Universitario A. Gemelli in Rome, Italy, and president of ESTRO, said, "Modern radiotherapy is increasingly able to provide less demanding treatments that preserve organ function. This study provides the radiotherapy community with a benchmark for erectile dysfunction, and I hope it will encourage more centers to include brachytherapy in their treatment options."

Preservation of Erectile Function

The study analyzed 542 patients who underwent permanent prostate brachytherapy from July 1999 to October 2013.

The men completed International Index of Erectile Function (IIEF) questionnaires before treatment, 1 month after treatment, then every 3 months for 2 years, every 6 months for up to 5 years, and then yearly.

The simplified 5-item version of the IIEF was used (questions 2, 4, 5, 7, and 15). The highest score (22 to 25) indicated no ED; lower scores indicated mild (17 to 21), mild/moderate (12 to 16), moderate (8 to 11), and severe (1 to 7) ED.

Only 21% of men had the highest scores before treatment, indicating no ED, and among this group 55.6% of those under age 60 years and 35% of those over age 60 years had maintained their full sexual function at 5 years after therapy, Dr. Oismüller reported.

When the category was widened to include men who had  "satisfactory" sexual function before treatment (scores of 17 to 21), defined as "able to achieve and maintain erection for satisfactory intercourse, even if sometimes suboptimal," 78% of men under age 60 and 65% of those over age 60 were able to maintain full or satisfactory  sexual function 5 years after treatment, she said.

Using a post-treatment score of 17 as a cutpoint, the study found that age had a significant effect , with 81.1% of patients under age 60 and 75.6% of those older than age 60 achieving that score at 2 years, and 76.5% and 74%, respectively, achieving it at 5 years (P = .0109).

Diabetes, hypertension, and smoking also had a significant effect on this cutpoint.

For patients without diabetes, 79.6% and 77% achieved an IIEF score of at least 17 at 2 and 5 years, respectively, regardless of age (P = .0099), compared with none of the patients with diabetes.

In patients without hypertension, 82.2% and 80.2% achieved an IIEF score of at least 17 at 2 and 5 years, respectively, compared with 67.3% and 62.5% of patients with hypertension (P = .0022).

Similarly, 80.1% and 77.3% of patients who did not smoke achieved this score at 2 and 5 years, respectively, compared with 51.8% of smokers at both time points (P = .0015).

Neither the addition of androgen deprivation nor external-beam radiotherapy affected sexual function scores.

The study found a high rate of ED among patients before treatment, with only 116 of 542 patients (21.4%) reporting no ED, said Dr. Oismüller. This subgroup of men was younger; their median age was 63.7 years, compared with 67.4 years for the rest of the cohort.

"We need guidelines to assess erectile function pretreatment and in follow-up," she said. "This would help to simplify comparisons of ED between different treatment modalities."

Dr. Oismüller and Dr. Henry have disclosed no relevant financial relationships.

European Society for Radiotherapy and Oncology (ESTRO) 33 Annual Conference. Abstract OC-0073. Presented April 5, 2014.

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