Sexual Function after Permanent Prostate Brachytherapy
Heather Jones, MD
University of Pennsylvania Cancer Center
Last Modified: November 7, 2001
Presenter: W.M. Butler
Presenter's Affiliation: Schiffler Cancer Center, Wheeling Hospital, Wheeling
Type of Session: Scientific
There continues to be uncertainty about the incidence of impotence after radiation therapy for prostate cancer. There is especially a paucity of information on prostate brachytherapy implants. This study evaluated the incidence of potency preservation following permanent prostate brachytherapy and evaluated the effect of multiple clinical and treatment parameters on penile erectile function.
MethodsPre-implant erectile function was assigned using a three-tiered scoring system (2 = erections always or nearly always sufficient for vaginal penetration; 1 = erections sufficient for vaginal penetration but considered suboptimal; 0 = the inability to obtain erections and/or erections inadequate for vaginal penetration--this was a physician questionnaire
Post-implant potency was defined as an IIEF score >11. Moderate erectile dysfunction for scores 6 to 10 less than 6 was consider impotent
Clinical parameters evaluated for sexual function included patient age, clinical T stage, and elapsed time since implantation, hypertension, diabetes mellitus, and tobacco consumption.
Evaluated treatment parameters included the utilization of neoadjuvant hormonal manipulation and the choice of isotope.
The efficacy of sildenafil citrate in brachytherapy induced erectile dysfunction (ED) was also evaluated.
Results209 patients who were potent before brachytherapy and currently not receiving hormonal manipulation were mailed an International Index of Erectile Function (IIEF) questionnaire with a pre-addressed stamped envelope.
There was a 87% response rate and 180 patients completed and returned the questionnaire.
Median patient follow-up was 39 months (range 18-74 months).
A pre-treatment erectile function score of 2 and 1 were assigned to 126 and 54 patients respectively.
At 6 years of follow up, 39% of patients maintained potency following prostate brachytherapy with a plateau on the curve.
Post-implant preservation of potency (IIEF >11) correlated with pre-implant erectile function (50% of patients with pre-implant of 2 versus 14% for pre-implant of 1, p <=0.0001)
Patient age correlated to potency (56% for men < 60 years of age, 38% for men 60 to 69 years of age, and 23% for patients >=70 years of age, p = 0.012)
History of diabetes mellitus was related to decrease potency
Neither clinical stage, utilization of neoadjuvant hormonal manipulation, the choice of isotope, a history of hypertension, or tobacco consumption had an effect on the ultimate preservation of potency.
Including pharmacologic support, 92% of patients maintained potency.
These results suggest that brachytherapy-induced ED is more common than previously reported and may be the result of obtaining patient information by means of a validated quality of life instrument by mail and not by personal interview. Pre-implant erectile function, patient age, and a history of diabetes mellitus were associated with the development of post-treatment ED.
Timely recognition of patients' sexual needs and dysfunctions is essential to comprehensive cancer care. Modes of assessment include open-ended conversations, structured diagnostic interviews, standardized self-report questionnaires, medical examination, and laboratory studies. This study highlights the need for standardized self report questionnaires in addition to interview when assessing quality of life issues, especially in the domain of sexual functioning. The study also demonstrates what others studies have shown, that most elderly men experienced a posttreatment sexual function course that differed greatly from the younger men. This finding validates the clinical observation that older men are much less likely than younger men to regain sexual function after treatment, even if prostate implant is the treatment of choice.
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