Erectile function after permanent 125I prostate brachytherapy for localized prostate cancer

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Abstract

Background and purpose

To analyze erectile function in men treated by prostate brachytherapy (PB) for localized prostate cancer.

Material and methods

Of a series of 270 sexually active men treated by PB, 241 (89%), mean age 65 yr (range, 43–80 yr), participated in a study on erectile function that was evaluated using the International Index of Erectile Function 5-item (IIEF-5) questionnaire before implantation and by postal survey after a mean follow-up of 36 months (range, 6–70 months).

Results

After PB, 27 patients (11%) had no erectile dysfunction (ED), 36 (15%) had mild ED, 58 (24%) had mild to moderate ED, 24 (10%) had moderate ED, 53 (22%) had severe ED and 43 (18%) were not sexually active. In patients with a preimplant IIEF score >12 (cut-off for intercourse with penetration), 73% had a deterioration of erectile function by at least one class after PB. Risk factors for ED after PB were age, preimplant IIEF score and prostate volume. Median time to ED onset was 16 months and was shorter with androgen deprivation (p = 0.007), diabetes (p = 0.03) and age over 55 (p = 0.01).

Conclusions

Following PB, the majority of patients progressively develop or major ED after a free interval that may last several months.

Support

Ligue Nationale contre le Cancer, France

Résumé

Objet

Etude de la fonction érectile chez les hommes traités par curiethérapie pour un cancer localisé de la prostate.

Matériels et Méthodes

A partir de 270 hommes sexuellement actifs, traités par curiethérapie, 241 (89%), moyenne d’âge 65 ans (entre, 43–80 ans), acceptaient de participer à l’étude de la fonction érectile après curiethérapie. Cette étude menée par le questionnaire validé IIEF 5 (International Index of Erectile Function 5-item), évaluait la fonction érectile avant curiethérapie, et en moyenne 36 mois (entre 6-70mois) après la curiethérapie de prostate. L’enquête était faite par envoi postal.

Résultats

Après la curiethérapie, 27 patients (11%) n’avaient pas de dysfonction érectile, 36 (15%) avaient une dysfonction très modérée, 58 (24%) entre très modérée et modérée, 24 (10%) modérée, 53 (22%) avaient une dysfonction érectile sévère et 43 (18%) n’étaient plus sexuellement actifs. Parmi les patients ayant un score IIEF avant curiethérapie >12 (score moyen permettant une pénétration pendant l’acte sexuelle), 73% avait une détérioration de leur fonction érectile d’au moins une classe IIEF. Les facteurs de risque de la dysfonction érectile après curiethérapie étaient: l’âge, le score IIEF avant curiethérapie et le volume de la prostate.

La période moyenne pour déclencher une dysfonction érectile après curiethérapie était de 16 mois. Cette période se réduisait lorsque les patients étaient sous hormonothérapie (p = 0.007), avaient du diabète (p = 0.03) et étaient âgés de plus de 55 ans (p = 0.01).

Conclusions

Après curiethérapie, la majorité des patients développaient progressivement une dysfonction érectile plusieurs mois après la curiethérapie.

Soutien

Ligue Nationale contre le Cancer, France

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Most cited references 18

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The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction.

R Rosen, A. Riley, G. Wagner … (1997)

To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction. Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity. A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort. The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.

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Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer.

Indulis Rutks, Roderick Macdonald, Tatyana Shamliyan … (2008)

The comparative effectiveness of localized prostate cancer treatments is largely unknown. To compare the effectiveness and harms of treatments for localized prostate cancer. MEDLINE (through September 2007), the Cochrane Library (through Issue 3, 2007), and the Cochrane Review Group in Prostate Diseases and Urologic Malignancies registry (through November 2007). Randomized, controlled trials (RCTs) published in any language and observational studies published in English that evaluated treatments and reported clinical or biochemical outcomes in localized prostate cancer. 2 researchers extracted information on study design, sample characteristics, interventions, and outcomes. 18 RCTs and 473 observational studies met inclusion criteria. One [one randomized controlled trial] [corrected] RCT enrolled mostly men without prostate-specific antigen (PSA)-detected disease and reported that, compared with watchful waiting, radical prostatectomy reduced crude [corrected] all-cause mortality (24% vs. 30%; P = 0.04) and prostate cancer-specific mortality (10% [corrected] vs. 15% [corrected]; P = 0.01) at 10 years [corrected] Effectiveness was limited to men younger than age 65 years but was not associated with Gleason score or baseline PSA level. An older, smaller trial found no significant overall survival differences between radical prostatectomy and watchful waiting (risk difference, 0% [95% CI, -19% to 18%]). Radical prostatectomy reduced disease recurrence at 5 years compared with external-beam radiation therapy in 1 small, older trial (14% vs. 39%; risk difference, 21%; P = 0.04). No external-beam radiation regimen was superior to another in reducing mortality. No randomized trials evaluated primary androgen deprivation. Androgen deprivation used adjuvant to radical prostatectomy did not improve biochemical progression compared with radical prostatectomy alone (risk difference, 0% [CI, -7% to 7%]). No randomized trial evaluated brachytherapy, cryotherapy, robotic radical prostatectomy, or photon-beam or intensity-modulated radiation therapy. Observational studies showed wide and overlapping effectiveness estimates within and between treatments. Adverse event definitions and severity varied widely. The Prostate Cancer Outcomes Study reported that urinary leakage (> or =1 event/d) was more common with radical prostatectomy (35%) than with radiation therapy (12%) or androgen deprivation (11%). Bowel urgency occurred more often with radiation (3%) or androgen deprivation (3%) than with radical prostatectomy (1%). Erectile dysfunction occurred frequently after all treatments (radical prostatectomy, 58%; radiation therapy, 43%; androgen deprivation, 86%). A higher risk score incorporating histologic grade, PSA level, and tumor stage was associated with increased risk for disease progression or recurrence regardless of treatment. Only 3 randomized trials compared effectiveness between primary treatments. No trial enrolled patients with prostate cancer primarily detected with PSA testing. Assessment of the comparative effectiveness and harms of localized prostate cancer treatments is difficult because of limitations in the evidence.

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Functional outcomes and complications following radiation therapy for prostate cancer: a critical analysis of the literature.

Lars Budäus, Michel Bolla, Alberto Bossi … (2012)

Prostate cancer (PCa) patients have many options within the realms of surgery or radiation therapy (RT). Technical advancements in RT planning and delivery have yielded different approaches, such as external beam, brachytherapy, and newer approaches such as image-guided tomotherapy or volumetric-modulated arc therapy. The selection of the optimal RT treatment for the individual is still a point of discussion, and the debate centres on two important outcomes-namely, cancer control and reduction of side-effects. To critically review and summarise the available literature on functional outcomes and rectal sequelae following RT for PCa treatment. A review of the literature published between 1999 and 2010 was performed using Medline and Scopus search. Relevant reports were identified using the terms prostate cancer, radiotherapy, functional outcomes, external beam radiation, brachytherapy, IMRT, quality of life, and tomotherapy and were critically reviewed and summarised. Related to nonuniform definition of their assessed functional end points and uneven standards of reporting, only a minority of series retrieved could be selected for analyses. Moreover, patterns of patient selection for different types of RT, inherent differences in the RT modalities, and the presence or absence of hormonal treatment also limit the ability to synthesise results from different publications or perform meta-analyses across the different treatment types. Nonetheless, several studies agree that recent technical improvements in the field of RT planning and delivery enable the administration of higher doses with equal or less toxicity. Regardless of the type of RT, the most frequently considered functional end points in the published analyses are gastrointestinal (GI) complications and rectal bleeding. Established risk factors for acute or late toxicities after RT include advanced age, larger rectal volume, a history of prior abdominal surgery, the concomitant use of androgen deprivation, preexisting diabetes mellitus, haemorrhoids, and inflammatory bowel disease (IBD). Similarly, mild acute irritative urinary symptoms are reported in several studies, whereas total urinary incontinence and other severe urinary symptoms are rare. Pretreatment genitourinary complaints, prior transurethral resection of the prostate (TURP), and the presence of acute genitourinary toxicity are suggested as contributing to long-term urinary morbidity. Erectile dysfunction (ED) is not an immediate side-effect of RT, and the occurrence of spontaneous erections before treatment is the best predictor for preserving erections sufficient for intercourse. In addition, the use of magnetic resonance imaging (MRI) permits a reduction in the dose delivered to vascular structures critical for erectile function. In the future, further improvement in RT planning and delivery will decrease side-effects and permit administration of higher doses. Related to the anatomy of the prostate, these higher doses may favour rectal sparing while not readily sparing the urethra and bladder neck. As a consequence, there may be a future shift from dose-limiting long-term rectal morbidity towards long-term urinary morbidity. In the absence of prospective randomised trials comparing different types of surgical and RT-based treatments in PCa, the introduction of validated tools for reporting functional and clinical outcomes is crucial for evaluating and identifying each individual's best treatment choice. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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Author and article information

Contributors

Patrice Njomnang Soh: sohnjomnang@yahoo.fr

Boris Delaunay: delaunay.b@chu-toulouse.fr

Matthieu Thoulouzan: thoulouzan.m@chu-toulouse.fr

Frederic Jonca: frederic.jonca@numericable.fr

Jean Marc Bachaud: bachaud.jean-marc@claudiusregaud.fr

Martine Delannes: martine.delannes@claudiusregaud.fr

Michel Soulie: soulie.m@chu-toulouse.fr

Eric Huyghe: eric.huyghe@yahoo.fr

Journal

Journal ID (nlm-ta): Basic Clin Androl

Journal ID (iso-abbrev): Basic Clin Androl

Title: Basic and Clinical Andrology

Publisher: BioMed Central (London )

ISSN (Print): 1166-2654

ISSN (Electronic): 2051-4190

Publication date (Electronic): 29 August 2013

Publication date PMC-release: 29 August 2013

Publication date Collection: 2013

Volume: 23

Electronic Location Identifier: 2

Affiliations

[ ]Department of Andrology, University Hospital Paule de Viguier, Paul Sabatier University, EA 3694 Toulouse, France

[ ]Department of Urology, University Hospital of rangueil, Toulouse, France

[ ]Clinique Ambroise Paré, Toulouse, France

[ ]Institut Claudius Régaud, Toulouse, France

[ ]Département d’Urologie CHU Rangueil, 1 av. Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France

Article

Publisher ID: 3

DOI: 10.1186/2051-4190-23-2

PMC ID: 4346293

SO-VID: 4ec121ee-c64a-4ca7-a05c-8a9637d366f5

License:

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 3 May 2013

Date accepted : 27 June 2013

Custom metadata

Keywords: erection,brachytherapy,sexual function,questionnaire,carcinoma of the prostate,érection,curiethérapie,function sexuelle,cancer de la prostate

Data availability:

Keywords: erection, brachytherapy, sexual function, questionnaire, carcinoma of the prostate, érection, curiethérapie, function sexuelle, cancer de la prostate

Erectile function after permanent 125I prostate brachytherapy for localized prostate cancer

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Abstract

Background and purpose

Material and methods

Results

Conclusions

Support

Résumé

Related collections

Probing cerebral hemodynamics with BOLD fMRI

Most cited references 18

The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction.

Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer.

Functional outcomes and complications following radiation therapy for prostate cancer: a critical analysis of the literature.

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