Effect of low dose‐rate prostate brachytherapy on the sexual health of men with optimal sexual function before treatment: analysis at ≥ 7 years of follow‐up

Abstract

OBJECTIVE To evaluate the effect of low‐dose rate prostate brachytherapy on the sexual health of men with ≥ 7 years of prospective evaluation and optimum sexual function before treatment. PATIENTS AND METHODS In all, 223 patients with T1b to T3a prostate cancer and a median (range) age of 66 (50–82) years were treated with permanent seed implantation from November 1990 to March 1998. They were followed for a median (range) of 8.2 (7–14.1) years using prospective quality‐of‐life measures. Erectile function (EF) was assessed using a physician‐assigned score and beginning in June 2000; the validated International Index of EF (IIEF‐5) was used as a complementary method to quantify late EF. No adjustment was made to differentiate sexual function with or with no pharmacological intervention for EF. Pearson’s chi‐square test and Student’s t‐test were used to compare the groups. RESULTS Of the 223 men, 131 (59%) had optimal EF before their brachytherapy; of these, 51 (40%) at the last follow‐up evaluation were using either a phosphodiesterase type 5 inhibitor (44, 86%), yohimbine (two, 4%) or alprostadil (five, 10%). The age at implantation was highly predictive of current EF; 23 of 25 (92%) men aged 50–59 years had a current EF of ≥ 2; those aged 60–69 and 70–78 years had an EF of ≥2 in 48/75 (64%) and 18/31 (58%) (P = 0.01). A current IIEF‐5 score of ≥ 16 also correlated highly with age at implant, i.e. 50–59, 16/25 (64%); 60–69, 20/75 (27%) and 70–78 years, 6/31 (19%) (P < 0.001). CONCLUSION Patients aged <60 years and with optimal EF before low‐dose rate prostate brachytherapy have a very high probability of long‐term EF.

Young Men Have Equivalent Biochemical Outcomes Compared With Older Men After Treatment With Brachytherapy for Prostate Cancer

“…Although an assessment of toxicity was not the main objective of this report, young men appeared less likely to experience erectile dysfunction following BT than older men, a finding than has been previously reported by our group and others (37)(38)(39)(40), whereas the incidence of rectal and gastrourinary toxicity appeared similar between the two age groups.…”

Brachytherapy with permanent seed implantation

“…56 Patients aged less than 60 years and with optimal erectile function before brachytherapy have a high probability of long-term maintenance of the function. 57 Neo-adjuvant hormonal treatment, existence of supplemental EBRT, total radiation dose delivered to the prostate, and diabetes can be factors that induce post-brachytherapy erectile dysfunction. Brachytherapy-induced erectile dysfunction responds favorably to a phosphodiesterase 5 inhibitor (PDEI), 54 and its early use is associated with a signifi cant improvement and maintenance of erectile function.…”

Defining potency: A comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite

“…17 Various studies have reported erectile function outcomes after radical prostatectomy, 18 brachytherapy, 19 or external-beam radiotherapy with or without brachytherapy 20,21 using the IIEF-5. Many more studies have used the EPIC to assess ED in prostate cancer patients.…”