Testosterone Levels and Sexual Quality of Life After Stereotactic Body Radiation Therapy for Prostate Cancer: A Multi-Institutional Analysis of Prospective Trials

Abstract

The impact of higher scatter doses per fraction on testicular function and quality of life after stereotactic body radiation therapy for prostate cancer is poorly studied. In this multi-institutional analysis of prospective trials of stereotactic body radiation therapy for low-to intermediate-risk prostate cancer, we found no clinically significant changes in testosterone or Expanded Purpose: The impact of higher scatter doses per fraction on testicular function and quality of life after prostate stereotactic body radiation therapy (SBRT) is poorly studied. Methods and Materials: Six hundred thirty-six patients treated with SBRT for low-to intermediate-risk prostate cancer from 2009 to 2014 were included. Changes in testosterone and in sexual and hormonal domain scores on the Expanded Prostate Cancer Index Composite-26 (EPIC) questionnaire over a 24-month period were evaluated via a 1-sided t test. EPIC score changes were evaluated in comparison with a distributionbased minimal clinically important difference threshold, wherein changes of greater than one half or greater than one third of the standard deviation in each domain were considered as medium-sized or small-sized effects, respectively. Results: Median and mean percent changes in testosterone at the 3-to 6-month, 7-to 12-month, 13-to 18-month, and 19-to 24-month time periods were À13.41% and À4.49% (P Z .02); À12.23% and À2.77% (P Z .13); À11.20% and À0.29% (P Z .47); À5.00% and þ 1.20% (P Z .65). When analyzed after dividing the cohort into 3 groups based on baseline testosterone values using tertiles, testosterone tended to

Self-Reported Burden in Elderly Patients With Localized Prostate Cancer Treated With Stereotactic Body Radiation Therapy (SBRT)

“…This is consistent with previous studies suggesting the diminished quality of life in patients who have been treated with ADT (12)(13)(14). What is surprising is that the self-reported burden in ADT cohort extended beyond the time frame in which testosterone recovery occurs (15,16). This suggests that the deleterious side effects of ADT continue to incur a burden on patients treated for localized prostate cancer.…”

Changes in sexual function and serum testosterone levels in patients with prostate cancer after image-guided proton therapy

“…Since Japanese patients do not have the habit of using drugs for erectile dysfunction, sexual summary scores may be lower than in Western countries. In patients who did not receive androgen deprivation therapy (ADT), sexual domain summary scores decreased, which is consistent with previous findings on SBRT, IMRT, brachytherapy and PT [ 12 , 33–38 ]. Although greater declines of 12–32 points were noted at 2–5 years in these studies than the decrease of 9.9 points at 36 months in the present study, it should be noted that these studies were from Western countries and the difference may be in part due to the low baseline levels of Japanese patients.…”

The Long-Term Effect of Intensity Modulated Radiation Therapy for Prostate Cancer on Testosterone Levels

“…Moreover, those previous studies that found increased posttreatment testosterone levels in patients with lower pretreatment level did not discuss this phenomenon. 6,9 A similar observation was reported by Taira et al who evaluated testosterone changes after Pd-103 brachytherapy with low-dose EBRT (20-45 Gy) in selected patients with intermediate-or high-risk prostate cancer. 15 They showed that men with higher pretreatment testosterone (>3.61 ng/mL) tended to experience a decrease in testosterone (P< .001), whereas men with average or below average baseline testosterone had no significant change.…”

“…A study by Yuan et al, which included 636 patients with prostate cancer treated with stereotactic body radiation therapy who were observed for up to 24 months, showed that the testosterone level tended to increase in patients in the first tertile group of baseline testosterone. 9 Yuan et al reported that patients with higher baseline levels of testosterone experienced a decline over time. However, they concluded that the decline was of unclear clinical significance because no patient reached hypogonadal or castrate levels of testosterone.…”

“…Previous studies on external-beam radiation therapy (EBRT) have evaluated changes in serum testosterone levels in patients receiving EBRT for prostate cancer 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 and other pelvic malignancies. 10 , 11 NRG Oncology, a newly developed clinical trials network group consisting of the coordinated efforts of the National Surgical Adjuvant Breast and Bowel Project, the Radiation Therapy Oncology Group (RTOG), and the Gynecologic Oncology Group recently reported on the RTOG 9408 randomized clinical trial and found that a total dose of 68.4 Gy to the prostate was only associated with a median decrease in testosterone of 13.5% at 3 months after treatment.…”