Erectile functioning of men treated for prostate carcinoma

Abstract

RESULTS. The probability of maintaining erectile functioning after radiotherapy is 0.69. The probability after surgery is 0.42. This difference is significant. Analysis of 3 Academic Computing Services, The University the effects of variables such as patient age and stage of disease on erectile functionof Calgary, Calgary, Alberta, Canada.ing could not be performed due to inconsistencies across studies and the limited number of studies reporting such variables. CONCLUSIONS.The published data indicate that men with normal erectile functioning are more likely to retain this function after radiotherapy than after surgery. Attention is drawn to the weaknesses in the reviewed studies in the hope that the clinical trials of emerging treatments, such as cryotherapy, brachytherapy, threedimensional conformal radiotherapy, and neoadjuvant hormones can be strengthened to reflect more accurately the rate of treatment-associated erectile dysfunction. Cancer 1997; 79:538-44. ᭧ 1997 American Cancer Society.KEYWORDS: prostatic neoplasms, prostatectomy, radiotherapy, penile erection, impotence. Increasingly larger numbers of men are being faced with the diagnosis of prostate carcinoma. It is estimated that 244,000 men a year receive this diagnosis in the U.S.1 With greater public demand for screening, this trend is unlikely to change.When a man receives a diagnosis of early stage prostate carcinoma, he has a choice of two treatments: radical prostatectomy or radical radiotherapy. Both are believed to be equally effective in curing this carcinoma.2,3 Health professionals and patients often look to published data on the complication rates of these treatments for guidance in choosing between treatments.Recently, the published data on complication rates have been used to calculate the trade-off between the potential negative impact of treatment. The suggestion is made that no treatment may, in fact, be the best choice for some men. 4 Hence, there is a need for accurate Received June 4, 1996, revision received October 7, 1996 accepted October 7, 1996. estimates of complication rates associated with treatments for pros-

Improving quality of life in men with prostate cancer: A randomized controlled trial of group education interventions.

“…A meta-analysis (Robinson, Dufour, & Fung, 1997) of 40 studies showed that the likelihood of erectile dysfunction is .58 after prostatectomy and .31 after radiotherapy. Longitudinal studies (e.g., Lubeck et al, 1999) have shown that urinary problems generally subside within a year after treatment, whereas sexual problems tend to persist.…”

The Contemporary Management of Prostate Cancer in the United States: Lessons From the Cancer of the Prostate Strategic Urologic Research Endeavor (Capsure), a National Disease Registry

“…58 Reported potency rates after EBRT and RP have varied widely from 2% to 86% of men following RT 59 -62 and 14% to 82% following RP. 31,63,64 This variance may be attributable to the limitations of physician reported outcome assessment, differences in patient populations, variation in time points relative to treatment at which potency is evaluated and the multiplicity of potency definitions used in contemporary studies. 65 We analyzed scores on the sexual function and bother domains of the PCI, comparing men who would be classified as potent or impotent based on the objective criterion of erections greater than 50% of the time when desired, and/or vaginal or anal intercourse at least 1 time in the prior 4 CONTEMPORARY PROSTATE CANCER MANAGEMENT IN UNITED STATES weeks, a definition best approximating the National Institutes of Health Consensus definition of impotence.…”

Prostate cancer and sexual function

“…12 Other data indicate that men with normal erectile function are more likely to retain this function after radiotherapy than after radical prostatectomy. 13 Testosterone appears to be necessary for the maintenance of libido in both men and women. 14 Drugs which signi®cantly decrease testosterone synthesis or block utilization have been associated with decreased libido.…”