Short‐term sexual function after prostate brachytherapy

Abstract

SUMMARY Sexual function was evaluated in 34 patients with low-risk prostate cancer (PSA ≤ 10, Gleason score ≤ 6, clinical stage T1/T2) undergoing brachytherapy in a phase III prospective randomized trial comparing iodine-125 ( 125 I) to palladium-103 ( 103 Pd). The mean and median International Index of Erectile Function (IIEF) scores for the entire group were 14.2 and 16.5, respectively, and there was no difference between these scores when stratified by isotope. IIEF scores < 6, 6 to 11, and ≥ 12 were recorded in 35% (12/34), 6% (2/34), and 59% (20/34) of patients, respectively. Hematospermia, orgasmalgia (pain at the time of orgasm), and alteration in intensity of orgasm were documented in 26% (9/34), 15% (5/34), and 38% (13/34) of patients, respectively, but these side effects were of limited duration for most patients. There was no relationship between radiation dose to the neurovascular bundles (NVB), which averaged 209% of the prescribed prostate dose, and the development of postbrachytherapy impotence. All four impotent patients who used sildenafil responded favorably. With a median follow-up of 13 months, 65% of patients undergoing prostate brachytherapy maintained sexual function without pharmacologic support. Including sildenafil responses, 76.5% of patients sustained erections sufficient for sexual intercourse.

Safety and efficacy of tamsulosin in the treatment of painful ejaculation: a randomized, double-blind, placebo-controlled study

“…Although ejaculatory pain in the general male population is considered to be 1%, 1 it is presented a serious problem for 88-91% of men who experience it. 2,3 It can be caused by prostatectomy, 4,5 a history of prostatitis, 6 pelvic radiation, 7,8 lower urinary tract symptoms (LUTS) diagnosed with clinical benign prostatic hyperplasia (BPH), 9,10 chronic pelvic pain disorder, 11 and neuroleptics. [12][13][14][15][16][17][18] On the other hand, PE as a sole entity is rare, and its etiology often remains unknown.…”

Management of Erectile Dysfunction Secondary to Treatment for Localized Prostate Cancer

“…However, the overall incidence of ED following external-beam radiation ranges from 41%-85% (Table 1) [5][6][7][8][9][10][11][12][13][14][15] and is dose-and age-dependent. 4 Three-dimensional conformal therapy (3D-CRT) may enhance the chance of preservation of erectile function sufficient for vaginal penetration the majority of patients.…”

Sexual function after permanent 125I-brachytherapy for prostate cancer

“…Reports from the literature show that 6-53% of patients could develop ED after permanent seed implantation. [1][2][3][4][5][6][7][8] These reported wide ranges of ED probably reflect differences in the length of followup, patient selection and the mode of data collection. In general, the series with longer follow-up periods show lower rates of potency preservation.…”

“…10 Several factors, including preimplant potency, patient age, the use of supplemental external-beam irradiation, radiation dose to the prostate gland, radiation dose to the bulb of the penis and diabetes mellitus, appear to exacerbate brachytherapy-related ED. 8,[12][13][14][15] DiBiase et al 16 have proposed that postimplant ED could be caused by the radiation damage to the nerve bundles and vascular structures. Some studies reported a strong correlation between the dose of radiotherapy delivered to the bulb of the penis and ED, 14,15 while others found no such correlation.…”

“…17 The majority of patients with brachytherapyinduced ED respond favorably to oral medication, such as sildenafil citrate. 8,10,[18][19][20][21][22] Despite reports questioning the potency-sparing advantage associated with brachytherapy, recent clarifications of brachytherapyrelated ED may result in refinement of treatment techniques, an increased likelihood of potency preservation and, ultimately, improved quality of life.…”