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Waraich TA, Khalid SY, Kathia UM, Ali A, Qamar SSS, Yousuf A, Saleem RMU. Assessing the Efficacy and Long-Term Outcomes of Surgical Intervention Versus Radiotherapy: A Comprehensive Systematic Review and Meta-Analysis of Prostate Cancer Treatment Modalities. Cureus 2024; 16:e58842. [PMID: 38784314 PMCID: PMC11115355 DOI: 10.7759/cureus.58842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
There is controversy regarding the most effective primary treatment of choice for prostate cancer (PCa) in terms of patient outcomes, such as surgery or radiotherapy (RT). This study evaluated the comparative efficacy and long-term outcomes of radical prostatectomy (RP) and RT for PCa treatment. A thorough literature review of relevant databases was conducted, focusing on academic and clinical studies published from 2019 onwards. The inclusion criteria included randomized controlled trials (RCTs) and other observational studies comparing survival outcomes in patients treated with surgery and RT. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to provide an overview of the data. We selected 19 studies based on the inclusion criteria. Of the total 19 studies, 12 advocated RP as the preferred treatment to improve survival outcomes in patients with PCa. The results of our synthesis showed that prostate cancer-specific mortality (PCSM) was lower in patients treated with RT. The total effect size for the analysis was calculated as Z=1.19 (p-value=0.23). The heterogeneity in the studies was as follows: Tau2=0.09, Chi2=20.25, df=4, I2=80%. Moreover, overall survival (OS) was shown to be higher in patients who underwent prostatectomy. The combined effect for the analysis was found to be: HR=0.97 (0.93, 1.01). The total effect was calculated as Z=1.33 (p-value= 0.18). The heterogeneity was found to be Tau2=0.00, Chi2=1.33, df=2, and I2=0%. However, overall mortality (OM) was shown to be independent of the treatment modality. RT is the preferred strategy for PCa treatment, as it balances efficacy and long-term outcomes. Clinical decision-making should consider individual patient characteristics and future research should delve into specific subpopulations and long-term outcomes to further refine the treatment guidelines.
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Affiliation(s)
| | - Syed Yousaf Khalid
- Department of Urology, Letterkenny University Hospital, Letterkenny, IRL
- Department of General Surgery, Letterkenny University Hospital, Letterkenny, IRL
- Department of Cardiothoracic Surgery, St. James's Hospital, Dublin, IRL
| | - Usama Muhammad Kathia
- Department of Urology and Kidney Transplantation, Lahore General Hospital, Lahore, PAK
| | - Azfar Ali
- Department of Urology and Kidney Transplantation, Lahore General Hospital, Lahore, PAK
| | | | - Ammar Yousuf
- Department of Urology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
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Yafi FA, Huynh LM, Ahlering T, Rosen R. What Is a "Validated Questionnaire"? A Critical Review of Erectile Function Assessment. J Sex Med 2020; 17:849-860. [PMID: 32146130 DOI: 10.1016/j.jsxm.2020.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/25/2019] [Accepted: 02/05/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND In recent years, the assessment of erectile dysfunction (ED) has experienced a paradigm shift from objective, quantitative methods to subjective, qualitative patient-reported outcomes. Facilitated by this shift is the ongoing debate on questionnaire selection and need for standardization, particularly among sexual medicine specialists. AIM To review current literature on assessment of erectile function via patient-reported outcomes and discuss the context, advantages, and limitations of currently available questionnaires. METHODS A thorough literature search of erectile function questionnaires developed from 1990 through 2019 was carried out using 3 methods: a search of the MedLine databases; hand-search of peer-reviewed urologic, sexual medicine, and health policy journals; and expert review. The following keywords were used: [assessment of], [inventory], [questionnaire], or [validated measure]; in combination with: [sexual function] or [erectile function]. Measures were stratified into one of the following 3 groups: screening, outcome, or disease-specific. 3 screening measures (International Index of Erectile Function, the Male Sexual Health Questionnaire, and Brief Male Sexual Inventory); 5 outcome measures (Sexual Health Inventory for Men, Erection Hardness Score, Erectile Dysfunction Inventory for Treatment and Satisfaction, and Treatment Satisfaction Scale); and 3 categories of disease-specific measures (cancer, Peyronie's disease, and spinal cord injury) were included. OUTCOMES Strengths, limitations, and valid uses of each erectile function questionnaire. RESULTS There currently exists a wide variety of screening, outcome, and disease-specific measures for ED diagnosis, assessment, and treatment. Rigor of psychometric validation varies greatly across studies. However, depending on purpose of use, all abovementioned questionnaires have merit for use in clinical practice, are nonredundant, and can complement and supplement one another. CLINICAL IMPLICATIONS Before choosing a specific measure for ED diagnosis, assessment, or treatment, there must be careful consideration of the questionnaire's psychometric properties, context of validation, and its possible limitations. STRENGTHS & LIMITATIONS The patient reported outcome measures highlighted in this article complement and supplement one another, as each emphasizes a related yet distinct central theme. During selection for use in clinical practice and research studies, special attention needs to be paid to the context, strengths, and weaknesses of each measure. CONCLUSION When used conscientiously, patient-reported questionnaires can significantly optimize patient management. Yafi FA, Huynh LM, Ahlering T, et al. What Is a "Validated Questionnaire"? A Critical Review of Erectile Function Assessment. J Sex Med 2020;17:849-860.
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Affiliation(s)
- Faysal A Yafi
- Department of Urology, University of California, Irvine Health Orange, CA, USA.
| | - Linda My Huynh
- Department of Urology, University of California, Irvine Health Orange, CA, USA
| | - Thomas Ahlering
- Department of Urology, University of California, Irvine Health Orange, CA, USA
| | - Raymond Rosen
- HealthCore/New England Research Institutes, Watertown, MA, USA
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Carter J, Lacchetti C, Andersen BL, Barton DL, Bolte S, Damast S, Diefenbach MA, DuHamel K, Florendo J, Ganz PA, Goldfarb S, Hallmeyer S, Kushner DM, Rowland JH. Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline. J Clin Oncol 2018; 36:492-511. [DOI: 10.1200/jco.2017.75.8995] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Purpose The adaptation of the Cancer Care Ontario (CCO) guideline Interventions to Address Sexual Problems in People With Cancer provides recommendations to manage sexual function adverse effects that occur as a result of cancer diagnosis and/or treatment. Methods ASCO staff reviewed the guideline for developmental rigor and updated the literature search. An ASCO Expert Panel ( Table A1 ) was assembled to review the guideline content and recommendations. Results The ASCO Expert Panel determined that the recommendations from the 2016 CCO guideline are clear, thorough, and based upon the most relevant scientific evidence. ASCO statements and modifications were added to adapt the CCO guideline for a broader audience. Recommendations It is recommended that there be a discussion with the patient, initiated by a member of the health care team, regarding sexual health and dysfunction resulting from cancer or its treatment. Psychosocial and/or psychosexual counseling should be offered to all patients with cancer, aiming to improve sexual response, body image, intimacy and relationship issues, and overall sexual functioning and satisfaction. Medical and treatable contributing factors should be identified and addressed first. In women with symptoms of vaginal and/or vulvar atrophy, lubricants in addition to vaginal moisturizers may be tried as a first option. Low-dose vaginal estrogen, lidocaine, and dehydroepiandrosterone may also be considered in some cases. In men, medication such as phosphodiesterase type 5 inhibitors may be beneficial, and surgery remains an option for those with symptoms or treatment complications refractory to medical management. Both women and men experiencing vasomotor symptoms should be offered interventions for symptomatic improvement, including behavioral options such as cognitive behavioral therapy, slow breathing and hypnosis, and medications such as venlafaxine and gabapentin.Additional information is available at: www.asco.org/survivorship-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Jeanne Carter
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Christina Lacchetti
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Barbara L. Andersen
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Debra L. Barton
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Sage Bolte
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Shari Damast
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Michael A. Diefenbach
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Katherine DuHamel
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Judith Florendo
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Patricia A. Ganz
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Shari Goldfarb
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Sigrun Hallmeyer
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - David M. Kushner
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Julia H. Rowland
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
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Barbera L, Zwaal C, Elterman D, McPherson K, Wolfman W, Katz A, Matthew A. Interventions to address sexual problems in people with cancer. Curr Oncol 2017; 24:192-200. [PMID: 28680280 PMCID: PMC5486385 DOI: 10.3747/co.24.3583] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sexual dysfunction in people with cancer is a significant problem. The present clinical practice guideline makes recommendations to improve sexual function in people with cancer. METHODS This guideline was undertaken by the Interventions to Address Sexual Problems in People with Cancer Expert Panel, a group organized by the Program in Evidence-Based Care (pebc). Consistent with the pebc standardized approach, a systematic search was conducted for existing guidelines, and the literature in medline and embase for the years 2003-2015 was systematically searched for both systematic reviews and primary literature. Evidence found for men and for women was evaluated separately, and no restrictions were placed on cancer type or study design. Content and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. RESULTS The search identified 4 existing guidelines, 13 systematic reviews, and 103 studies with relevance to the topic. The present guideline provides one overarching recommendation concerning the discussion of sexual health and dysfunction, which is aimed at all people with cancer. Eleven additional recommendations made separately for men and women deal with issues such as sexual response, body image, intimacy and relationships, overall sexual functioning and satisfaction, and vasomotor and genital symptoms. CONCLUSIONS To our knowledge this clinical practice guideline is the first to comprehensively evaluate interventions for the improvement of sexual problems in people with cancer. The guideline will be a valuable resource to support practitioners and clinics in addressing sexuality in cancer survivors.
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Affiliation(s)
- L. Barbera
- Department of Radiation Oncology, University of Toronto, Toronto
| | - C. Zwaal
- Program in Evidence-Based Care, Cancer Care Ontario, Hamilton
| | - D. Elterman
- Department of Surgery, Division of Urology, University of Toronto, Toronto
| | - K. McPherson
- Patient and Family Advisory Council, Cancer Care Ontario, Hamilton; and
| | - W. Wolfman
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; and
| | - A. Katz
- CancerCare Manitoba, Winnipeg, MB
| | - A. Matthew
- Department of Surgery, Division of Urology, University of Toronto, Toronto
| | - The Interventions to Address Sexual Problems in People with Cancer Guideline Development Group
- Department of Radiation Oncology, University of Toronto, Toronto
- Program in Evidence-Based Care, Cancer Care Ontario, Hamilton
- Department of Surgery, Division of Urology, University of Toronto, Toronto
- Patient and Family Advisory Council, Cancer Care Ontario, Hamilton; and
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; and
- CancerCare Manitoba, Winnipeg, MB
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Hudson SV, O'Malley DM, Miller SM. Achieving optimal delivery of follow-up care for prostate cancer survivors: improving patient outcomes. PATIENT-RELATED OUTCOME MEASURES 2015; 6:75-90. [PMID: 25834471 PMCID: PMC4372007 DOI: 10.2147/prom.s49588] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Prostate cancer is the most commonly diagnosed cancer in men in the US, and the second most prevalent cancer in men worldwide. High incidence and survival rates for prostate cancer have resulted in a large and growing population of long-term prostate cancer survivors. Long-term follow-up guidelines have only recently been developed to inform approaches to this phase of care for the prostate cancer population. Methods A PubMed search of English literature through August 2014 was performed. Articles were retrieved and reviewed to confirm their relevance. Patient-reported measures that were used in studies of long-term prostate cancer survivors (ie, at least 2 years posttreatment) were reviewed and included in the review. Results A total of 343 abstracts were initially identified from the database search. After abstract review, 105 full-text articles were reviewed of which seven met inclusion criteria. An additional 22 articles were identified from the references of the included articles, and 29 were retained. From the 29 articles, 68 patient-reported outcome measures were identified. The majority (75%) were multi-item scales that had been previously validated in existing literature. We identified four main areas of assessment: 1) physical health; 2) quality of life – general, physical, and psychosocial; 3) health promotion – physical activity, diet, and tobacco cessation; and 4) care quality outcomes. Conclusion There are a number of well-validated measures that assess patient-reported outcomes that document key aspects of long-term follow-up with respect to patient symptoms and quality of life. However, there are fewer patient-reported outcomes related to health promotion and care quality within the prevention, surveillance, and care coordination components of cancer survivorship. Future research should focus on development of additional patient-centered and patient-related outcomes that enlarge the assessment portfolio.
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Affiliation(s)
- Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Somerset
| | | | - Suzanne M Miller
- Cancer Prevention and Control Program, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
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Obayomi-Davies O, Chen LN, Bhagat A, Wright HC, Uhm S, Kim JS, Yung TM, Lei S, Batipps GP, Pahira J, McGeagh KG, Collins BT, Kowalczyk K, Bandi G, Kumar D, Suy S, Dritschilo A, Lynch JH, Collins SP. Potency preservation following stereotactic body radiation therapy for prostate cancer. Radiat Oncol 2013; 8:256. [PMID: 24180317 PMCID: PMC4228383 DOI: 10.1186/1748-717x-8-256] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Erectile dysfunction after prostate radiation therapy remains an ongoing challenge and critical quality of life issue. Given the higher dose of radiation per fraction using stereotactic body radiation therapy (SBRT) there is concern that post-SBRT impotency would be higher than conventional radiation therapy approaches. This study sought to evaluate potency preservation and sexual function following SBRT for prostate cancer. METHODS Between February 2008 and March 2011, 216 men with clinically localized prostate cancer were treated definitively with SBRT monotherapy at Georgetown University Hospital. Potency was defined as the ability to have an erection firm enough for intercourse with or without sexual aids while sexual activity was defined as the ability to have an erection firm enough for masturbation and foreplay. Patients who received androgen deprivation therapy (ADT) were excluded from this study. Ninety-seven hormone-naïve men were identified as being potent at the initiation of therapy and were included in this review. All patients were treated to 35-36.25 Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Prostate specific antigen (PSA) and total testosterone levels were obtained pre-treatment, every 3 months for the first year and every 6 months for the subsequent year. Sexual function was assessed with the Sexual Health Inventory for Men (SHIM), the Expanded Prostate Index Composite (EPIC)-26 and Utilization of Sexual Medication/Device questionnaires at baseline and all follow-up visits. RESULTS Ninety-seven men (43 low-, 50 intermediate- and 4 high-risk) at a median age of 68 years (range, 48-82 years) received SBRT. The median pre-treatment PSA was 5.9 ng/ml and the minimum follow-up was 24 months. The median pre-treatment total serum testosterone level was 11.4 nmol/L (range, 4.4-27.9 nmol/L). The median baseline SHIM was 22 and 36% of patients utilized sexual aids prior to treatment. Although potency rates declined following treatment: 100% (baseline); 68% (6 months); 62% (12 months); 57% (18 months) and 54.4% (24 months), 78% of previously potent patients had erections sufficient for sexual activity at 24 months post-treatment. Overall sexual aid utilization increased from 36% at baseline to 49% at 24 months. Average EPIC sexual scores showed a slow decline over the first two years following treatment: 77.6 (baseline); 68.7 (6 months); 63.2 (12 months); 61.9 (18 months); 59.3 (24 months). All sexual functions including orgasm declined with time. Prior to treatment, 13.4% of men felt their sexual function was a moderate to big problem which increased to 26.7% two years post treatment. Post-treatment testosterone levels gradually decreased with a median value at two year follow-up of 10.7 nmol/L. However, the average EPIC hormonal scores did not illustrate a statistically significant difference two years post-treatment. Review of the radiation doses to the penile bulb in this study, a potential marker of post-treatment sexual function, revealed that the dose was relatively low and at these low doses the percentage of the penile bulb receiving 29.5 Gy did not correlate with the development of ED. CONCLUSIONS Men undergoing SBRT monotherapy for prostate cancer report sexual outcomes comparable to those reported for conventional radiation modalities within the first 24 months after treatment. Longer follow-up is required to confirm the durability of these findings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA.
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Basal S, Wambi C, Acikel C, Gupta M, Badani K. Optimal strategy for penile rehabilitation after robot-assisted radical prostatectomy based on preoperative erectile function. BJU Int 2012. [DOI: 10.1111/j.1464-410x.2012.11487.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Chris Wambi
- Department of Urology; Columbia University Medical Center; New York; NY; USA
| | - Cengizhan Acikel
- Department of Urology; School of Medicine; Gulhane Military Medical Academy; Ankara; Turkey
| | - Mantu Gupta
- Department of Urology; Columbia University Medical Center; New York; NY; USA
| | - Ketan Badani
- Department of Urology; Columbia University Medical Center; New York; NY; USA
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Matsushima M, Kikuchi E, Maeda T, Nakashima J, Sugawara A, Ando T, Mizuno R, Nagata H, Miyajima A, Shigematsu N, Oya M. A prospective longitudinal survey of erectile dysfunction in patients with localized prostate cancer treated with permanent prostate brachytherapy. J Urol 2012; 189:1014-8. [PMID: 23017516 DOI: 10.1016/j.juro.2012.09.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Few studies have evaluated changes in erectile function with time before and after prostate brachytherapy using the International Index of Erectile Function-15, a sensitive, validated tool for assessing male sexual dysfunction. In this prospective study we evaluated the natural history of erectile function after prostate brachytherapy without supplemental therapy (external beam radiotherapy, phosphodiesterase-5 inhibitors or androgen deprivation therapy) using the International Index of Erectile Function-15. MATERIALS AND METHODS We identified 119 patients who were followed at least 12 months after prostate brachytherapy between 2004 and 2010. Sexual and erectile function status were assessed before brachytherapy (baseline), and 3, 6, 12, 18, 24 and 36 months postoperatively using the International Index of Erectile Function-15. RESULTS Mean total International Index of Erectile Function-15 score, and scores on the erectile function, orgasmic function, sexual desire and intercourse satisfaction domains 3 months after brachytherapy were significantly lower than at baseline (p <0.05). They remained lower until 36 months after prostate brachytherapy. Erectile function was maintained 12 months after brachytherapy in 16 of the 48 men (33.3%) with a baseline erectile function domain score of 11 or greater. There was no significant difference in clinical features except the age of patients who maintained the erectile function domain score and their counterparts 12 months after brachytherapy. Multivariate analysis revealed that age 70 years or greater was the only predictive factor for deteriorating erectile function after brachytherapy (p = 0.035). CONCLUSIONS Findings indicate a global decrease in all domains of the International Index of Erectile Function-15 score 12 months after prostate brachytherapy. Also, patient age may influence the preservation of brachytherapy related potency.
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Park KK, Lee SH, Chung BH. The effects of long-term androgen deprivation therapy on penile length in patients with prostate cancer: a single-center, prospective, open-label, observational study. J Sex Med 2011; 8:3214-9. [PMID: 21699669 DOI: 10.1111/j.1743-6109.2011.02364.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The adverse effects of long-term drug therapy for prostate cancer (PCa) can dramatically impact patient quality of life and are considered to be important factors when selecting treatment. AIM To assess stretched penile length before and after long-term androgen deprivation therapy (ADT) for treatment of PCa. METHODS From January 2008 to June 2010 at a single institution, 39 consecutive patients without distant metastases who were elected to receive ADT as initial therapy for PCa were prospectively enrolled. Exclusion criteria were history of penile anomalies and/or trauma, and prior radical prostate surgery or radiation therapy. Erectile functions were evaluated at baseline according to the International Index of Erectile Function (IIEF). Vertically stretched penile length was measured every 3 months from the pubopenile junction to the meatus with a spring scale. MAIN OUTCOME MEASURE After ADT, significant 3-month interval changes in stretched penile length were noted for up to 15 months (P < 0.001). The relationship between potency and penile shortening was not significant (P = 0.45). RESULTS The mean patient age was 67.1 years. Before therapy, the mean stretched penile length was 10.76 cm. After 24 months of ADT, mean penile length had decreased to 8.05 cm. However, these changes plateaued after 15 months. Normal erectile function (EF) was reported by 41% of patients before therapy, while 10.5% reported normal EF at the 24-month follow-up. The relationship between potency and penile shortening was not significant. However, patients who preserved their potency tended to experience less penile shortening. CONCLUSIONS The administration of luteinizing hormone-releasing hormone (LHRH) agonists induced significant decreases in penile length for only up to 15 months in the absence of the confounding effects of surgery and radiation.
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Affiliation(s)
- Kyung Kgi Park
- Department of Urology, Yongin Severance Hospital, Urological Science Institute, Yonsei University Health System, Yongin, Korea
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Sexual quality of life for localized prostate cancer: a cross-cultural study between Japanese and American men. Reprod Med Biol 2011; 10:59-68. [PMID: 29699082 DOI: 10.1007/s12522-011-0076-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 01/07/2011] [Indexed: 10/18/2022] Open
Abstract
Introduction Race and ethnicity are important factors in health-related quality of life (QOL) because of racial differences in preferences for, and trust in, health systems. Such factors are likely to affect QOL and patient satisfaction with care. Results Using a self-reported questionnaire, Japanese men with prostate cancer reported lower sexual function scores at baseline. In detail, Japanese men were more likely than American men to report poor sexual desire, poor erection ability, poor overall ability to function sexually, poor ability to attain orgasm, poor quality of erections, infrequency of erections, infrequency of morning erections, and intercourse in the previous 4 weeks. However, Japanese men were less likely than American men to be concerned about their sexual function. Two years after surgery, American patients were more likely than Japanese patients to regain their baseline sexual function. The use of phosphodiesterase-5 (PDE-5) inhibitors has been widely publicized as the solution to erectile dysfunction after prostate cancer treatment. Although PDE-5 inhibitors have been available in Japan since 1999, it is striking that Japanese men with localized prostate cancer are much less likely (only 10%) to use PDE-5 inhibitors than American men. Conclusion Japanese patients with localized prostate cancer report worse sexual function but are less concerned about their reduced function. In the absence of a biological explanation for such differences, however, we suspect that cultural differences may explain the differences between QOL survey results from Japanese or American men with prostate cancer.
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Neviani CB, Miziara MA, de Andrade Carvalho H. Results of high dose-rate brachytherapy boost before 2D or 3D external beam irradiation for prostate cancer. Radiother Oncol 2011; 98:169-74. [DOI: 10.1016/j.radonc.2011.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 01/05/2011] [Accepted: 01/12/2011] [Indexed: 11/28/2022]
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Sadovsky R, Brock GB, Gray M, Jensen PK, Gutkin SW, Sorsaburu S. Optimizing treatment outcomes with phosphodiesterase type 5 inhibitors for erectile dysfunction: Opening windows to enhanced sexual function and overall health. ACTA ACUST UNITED AC 2011; 23:320-30. [DOI: 10.1111/j.1745-7599.2010.00590.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wiegner EA, King CR. Sexual function after stereotactic body radiotherapy for prostate cancer: results of a prospective clinical trial. Int J Radiat Oncol Biol Phys 2010; 78:442-8. [PMID: 20137864 DOI: 10.1016/j.ijrobp.2009.07.1748] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 07/26/2009] [Accepted: 07/29/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the sexual quality of life for prostate cancer patients after stereotactic body radiotherapy (SBRT). METHODS AND MATERIALS Using the Expanded Prostate Cancer Index Composite (EPIC)-validated quality-of-life questionnaire, the sexual function of 32 consecutive patients who received prostate SBRT in a prospective Phase II clinical trial were analyzed at baseline, and at median times of 4, 12, 20, and 50 months after treatment. SBRT consisted of 36.25 Gy in five fractions of 7.25 Gy using the Cyberknife. No androgen deprivation therapy was given. The use of erectile dysfunction (ED) medications was monitored. A comprehensive literature review for radiotherapy-alone modalities based on patient self-reported questionnaires served as historical comparison. RESULTS Median age at treatment was 67.5 years, and median follow-up was 35.5 months (minimum 12 months). The mean EPIC sexual domain summary score, sexual function score, and sexual bother score decreased by 45%, 49%, and 25% respectively at 50 months follow-up. These differences reached clinical relevance by 20 months after treatment. Baseline ED rate was 38% and increased to 71% after treatment (p = 0.024). Use of ED medications was 3% at baseline and progressed to 25%. For patients aged <70 years at follow-up, 60% maintained satisfactory erectile function after treatment compared with only 12% aged ≥70 years (p = 0.008). Penile bulb dose was not associated with ED. CONCLUSIONS The rates of ED after treatment appear comparable to those reported for other modalities of radiotherapy. Given the modest size of this study and the uncertainties in the physiology of radiotherapy-related ED, these results merit further investigations.
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Affiliation(s)
- Ellen A Wiegner
- Department of Radiation Oncology, Stanford University School of Medicine, CA, USA
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Traeger L, Penedo FJ, Gonzalez JS, Dahn JR, Lechner SC, Schneiderman N, Antoni MH. Illness perceptions and emotional well-being in men treated for localized prostate cancer. J Psychosom Res 2009; 67:389-97. [PMID: 19837201 DOI: 10.1016/j.jpsychores.2009.03.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 02/25/2009] [Accepted: 03/31/2009] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Emotional adjustment to cancer survivorship may be influenced by how patients interpret treatment side effects and other cancer-related experiences. The current study examined cognitive representations of illness, as conceptualized by the Self-Regulatory Model (SRM), in men treated for localized prostate cancer (PC). More severe PC perceptions were hypothesized to predict poorer emotional well being, particularly among men experiencing greater post-treatment sexual dysfunction or general life stress. METHODS The Perceived Stress Scale, Expanded Prostate Cancer Index Composite, Illness Perception Questionnaire-Revised, and Functional Assessment of Cancer Therapy were administered to 214 men within 18 months of completing treatment for early stage PC. RESULTS Perceptions that PC was less comprehensible, was less likely to be controlled by treatment, and was more likely caused by one's own personality and behaviors remained associated with poorer emotional well being after adjusting for relevant medical and demographic factors. Life stress moderated the relationship between perceived consequences of PC and emotional well-being, such that more severe perceptions of negative consequences predicted poorer emotional well-being only for men experiencing higher life stress. Degree of sexual dysfunction did not moderate any relationships between cancer perceptions and emotional well-being. CONCLUSION Within 18 months of completing treatment for localized PC, more severe perceived consequences of PC were associated with poorer emotional well-being, particularly among men experiencing greater life stress. Interventions that target distortions in illness perceptions may enhance emotional adjustment among the most distressed PC survivors.
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Affiliation(s)
- Lara Traeger
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Akbal C, Tinay I, Simşek F, Turkeri LN. Erectile dysfunction following radiotherapy and brachytherapy for prostate cancer: pathophysiology, prevention and treatment. Int Urol Nephrol 2008; 40:355-63. [PMID: 17960489 DOI: 10.1007/s11255-007-9247-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 05/29/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although detrimental impact on sexual function following radiotherapy (RT) and brachytherapy decreases the quality of life of prostate cancer survivors, the etiology, pathophysiology, prophylaxis and treatment of this condition has not yet been fully clarified. We reviewed the published literature in terms of etiology, treatment and possible prevention of erectile dysfunction (ED) following RT and/or brachytherapy. METHOD We have reviewed the literature through a MEDLINE search. Prostate cancer, erectile dysfunction, radiotherapy, brachytherapy, treatment and quality of life were used as keywords. CONCLUSION Both RT and brachytherapy result in high rates of ED. Although arterial damage seems to be the main cause of ED after RT, exposure of neurovascular bundle to high levels of radiation dose has been also implicated in some studies with brachytherapy. The radiation dose received by the corpora cavernosa at the crurae of the penis may also be important in the etiology of ED. The most important predictive factor of ED following RT is the treatment modality. Intensity-modulated radiotherapy and vessel-sparing prostate radiotherapy are new techniques but those treatments may not guarantee complete preservation of the erectile function. Patients need to be correctly informed on the possible sequela of radiation-based treatments on their sexual well-being while planning their treatment. Patients should also be informed about the possible treatment modalities for ED, which may develop in due course.
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Affiliation(s)
- Cem Akbal
- Department of Urology, Marmara University School of Medicine, Marmara University Hospital, Tophanelioglu Caddesi No 13-15, 34662 Altunizade Istanbul, Turkey.
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Cappelleri JC, Stecher VJ. An assessment of patient-reported outcomes for men with erectile dysfunction: Pfizer's perspective. Int J Impot Res 2008; 20:343-57. [PMID: 18368055 DOI: 10.1038/ijir.2008.8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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The Impact of Treatment Choice for Localized Prostate Cancer on Response to Phosphodiesterase Inhibitors. J Urol 2008; 179:1072-6; discussion 1076. [DOI: 10.1016/j.juro.2007.10.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Indexed: 11/21/2022]
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18
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Krupski TL, Litwin MS. Medical and Psychosocial Issues in Prostate Cancer Survivors. Oncology 2007. [DOI: 10.1007/0-387-31056-8_107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Raina R, Pahlajani G, Agarwal A, Zippe CD. The early use of transurethral alprostadil after radical prostatectomy potentially facilitates an earlier return of erectile function and successful sexual activity. BJU Int 2007; 100:1317-21. [PMID: 17850385 DOI: 10.1111/j.1464-410x.2007.07124.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess whether early introduction of the Medicated Urethral System for Erection (MUSE(TM), Vivus Inc., Mountain View, CA, USA) after radical prostatectomy (RP) results in a shorter recovery time for the return to functional erections and successful sexual activity. PATIENTS AND METHODS In a prospective study of 91 sexually active men who had a nerve-sparing RP for prostate cancer, 56 were treated with MUSE (125 or 250 microg three times per week for 6 months) while the remaining 35 had no erectogenic aids, except as necessary when attempting sexual activity. Self-administration of MUSE was initiated approximately 3 weeks after RP. Treatment efficacy was analysed by the patient's response to the Sexual Health Inventory for Men (SHIM) questionnaire. RESULTS The mean patient age was approximately 59 years and the median follow-up 6 months; the compliance rate was 68%. Patients reported a significant improvement in all domains of the SHIM questionnaire after using MUSE. At the end of 6 months 74% of the patients who remained on MUSE were able to have successful vaginal intercourse. Of patients who completed the 6-month course of MUSE, half were able to have successful vaginal intercourse by the end of treatment. Most of these patients reported the recovery of spontaneous erections and required no additional erectogenic aids for successful intercourse. They had a mean SHIM score of 18.9. All 56 patients who received MUSE reported mild penile aching or urethral burning, and of these, 32% discontinued treatment. In the untreated control group, 37% regained erections sufficient for vaginal intercourse at the 6-month follow-up, with a mean SHIM score of 15.8. Of the control patients who recovered penile function, 71% were dissatisfied with the quality of their erections and sought adjuvant therapy. CONCLUSIONS Initiating MUSE shortly after RP is safe and tolerable, and appears to shorten the recovery time to reagin erectile function.
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Affiliation(s)
- Rupesh Raina
- Department of Internal Medicine and Paediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
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Trojan L, Harrer K, Schäfer J, Voss M, Welzel G, Bolenz C, Wenz F, Alken P, Michel MS. Komplikationen und Nebenwirkungen der LDR-Brachytherapie beim Prostatakarzinom. Urologe A 2007; 46:1542-7. [PMID: 17622506 DOI: 10.1007/s00120-007-1369-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Brachytherapy (BT) is an established treatment option for low risk prostate cancer. The aim of this study was to determine the long-term complications and side effects of the procedure in an up to 13 year long single center follow-up analysis. MATERIAL A total of 505 patients were treated by BT for prostate cancer between May 1991 and August 2005. Cohort I (n=412; May 1991 to November 2003) was evaluated by written questionnaire (modified ICS male) and patient chart evaluation in terms of side effects and secondary interventions. In cohort II (n=148; January 2002 to August 2005) perioperative complications were investigated. RESULTS The mean follow-up was 5.5 years. Perioperative complications were present in 5.4% of patients. Transurethral resection of the prostate was a common secondary intervention, performed in 7% of cases. The rate of incontinence was 6.3% in the long-term follow-up, the rate of potency was 43.5% in those patients who were potent before BT and no hormonal manipulation was performed at any time. CONCLUSION BT is a minimally invasive procedure for the treatment of localised "low risk" prostate cancer. Perioperative complications are rare, secondary intervention may be necessary and the patient has to be informed of possible impotence, incontinence and lack of ejaculation.
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Affiliation(s)
- L Trojan
- Urologische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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21
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Haliloglu A, Baltaci S, Yaman O. Penile length changes in men treated with androgen suppression plus radiation therapy for local or locally advanced prostate cancer. J Urol 2007; 177:128-30. [PMID: 17162022 DOI: 10.1016/j.juro.2006.08.113] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE We determined penile length alterations in men treated with androgen suppression plus radiation therapy for local or locally advanced prostate cancer. MATERIALS AND METHODS From November 2000 to November 2005, 47 patients were enrolled in this prospective study. After clinical staging all patients received hormonal therapy (luteinizing hormone releasing agonist, leuprolide acetate or goserelin every 3 months for a total of 3 injections) and at month 7 of hormonal therapy radiation therapy was begun (total 70 Gy) for 7 weeks. Stretched penile length measurements were performed before starting androgen suppression therapy and every 3 months thereafter with a paper ruler. RESULTS With the initiation of therapy a gradual decrease in stretched penile length was observed. Penile shortening was statistically significant at a mean followup of 18 months (mean 14.2 to 8.6 cm, p <0.001). CONCLUSIONS Our findings support observations of decreased penile length after neoadjuvant hormonal therapy plus external beam radiation therapy for local or locally advanced prostate cancer. Patients should be counseled before therapy that penile shortening may occur.
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Affiliation(s)
- Ahmet Haliloglu
- University of Ankara, Faculty of Medicine, Department of Urology, Ankara, Turkey.
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22
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Schiff JD, Bar-Chama N, Cesaretti J, Stock R. Early use of a phosphodiesterase inhibitor after brachytherapy restores and preserves erectile function. BJU Int 2006; 98:1255-8. [PMID: 17125483 DOI: 10.1111/j.1464-410x.2006.06441.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether the early use of phosphodiesterase inhibitors (PDEIs) after brachytherapy (BT) is associated with better erectile function, as of men potent before BT 38-70% have erectile dysfunction afterward. PATIENTS AND METHODS We evaluated a prospectively created database of 2500 patients who had had BT at our institution since 1992. We measured baseline age, cancer stage, Gleason grade, prostate specific antigen (PSA) level at diagnosis, implant type, use of neoadjuvant and adjuvant hormonal suppression therapy, use of external beam radiotherapy in conjunction with interstitial therapy, and follow-up PSA levels. Men were stratified by their use of PDEIs at <1 year (early group) or >1 year after implantation (late group). We excluded all men who did not have baseline Sexual Health Inventory for Men (SHIM) scores and at least one follow-up SHIM score; the latter were obtained at 6-month intervals after BT. Data were analysed using the Mann-Whitney U-test. RESULTS In all, 210 men met the inclusion criteria; 85 began using PDEIs within a year of BT, and 125 started after a year. The mean time to PDEI use was 191 days in the early and 595 days in the late group. The median age was 62 years in the early and 63 years in the late group (P = 0.02). Baseline Gleason scores did not differ, nor did PSA levels between the groups. Of men in the early group, 48% received neoadjuvant and/or adjuvant hormonal suppression therapy, vs half of men in the late group. Baseline SHIM scores were not significantly different, nor were scores at the first two follow-up assessments, but the scores at 18-36 months after BT were significantly different. CONCLUSION The early use of PDEIs after BT is associated with a significant improvement in and maintenance of erectile function compared with late use. Men undergoing BT should be encouraged to use PDEIs early after implantation, to preserve erectile function.
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Abstract
Higher doses of radiation result in improved clinical control of prostate cancer,and the recent advances in prostate cancer radiotherapy are designed to escalate dose while minimizing toxicity. To achieve this goal, tighter treatment margins are needed, which require more accurate delineation of the prostate target and normal tissue at the time of treatment planning and before actual daily treatments. Modem radiation therapy techniques can deposit conformal dose virtually anywhere in the body; however, this precise therapy is of no value if it is not accurately hitting the target. Whether dose escalation is achieved by external beam techniques (eg, IMRT, protons) or brachytherapy, these ba-sic planning and delivery considerations are essentially the same. Future directions in prostate radiation therapy will use even higher radiation doses,alternative fractionation patterns, intraprostatic targets (eg, prostate tumor seen on MRI), and improved patient selection regarding which patients will benefit the most from these advanced techniques.
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Affiliation(s)
- Andrew K Lee
- Division of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Padma-Nathan H. Sildenafil citrate (Viagra) treatment for erectile dysfunction: An updated profile of response and effectiveness. Int J Impot Res 2006; 18:423-31. [PMID: 16810179 DOI: 10.1038/sj.ijir.3901492] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the 7 years since sildenafil citrate (VIAGRA) was introduced as the first oral phosphodiesterase type 5 inhibitor therapy for erectile dysfunction, it has been used to treat nearly 27 million men with erectile dysfunction worldwide. Patient populations with erectile dysfunction of varying etiologies and with diverse comorbidities have benefited from sildenafil treatment. This update focuses on relatively recent research that further defines the response and effectiveness profiles of sildenafil and provides additional insight into optimizing treatment. In addition to providing recent data on sildenafil efficacy and safety/tolerability, the update provides data on assessments of erection hardness, measures of psychosocial outcomes (e.g., emotional well-being and treatment satisfaction), and treatment approaches to maximize response and effectiveness (e.g., by titrating to the maximum tolerated dose). Increased understanding of the sildenafil response and effectiveness profiles and optimal sildenafil treatment are central to the appropriate management of erectile dysfunction using sildenafil.
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Affiliation(s)
- H Padma-Nathan
- Clinical Professor of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Speight JL, Roach M. Radiotherapy in the management of common genitourinary malignancies. Hematol Oncol Clin North Am 2006; 20:321-46. [PMID: 16730297 DOI: 10.1016/j.hoc.2006.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A continued role for radiation therapy in the multidisciplinary management of genitourinary malignancies seems certain. Treatment outcomes continue to improve, accompanied by diminishing rates of toxicity. With continued technologic advances in the delivery of radiation, including the use of adaptive radiotherapy, the discovery and application of novel treatment agents, and the combined efforts of urologists, medical oncologists, and radiation oncologists, patients who have genitourinary malignancies have an excellent chance of cure.
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Affiliation(s)
- Joycelyn L Speight
- Department of Radiation Oncology, University of California San Francisco Comprehensive Cancer Center, H1031, 1600 Divisadero Street, San Francisco, CA 94143, USA.
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Mulhall J, Ahmed A, Parker M, Mohideen N. The hemodynamics of erectile dysfunction following external beam radiation for prostate cancer. J Sex Med 2006; 2:432-7. [PMID: 16422876 DOI: 10.1111/j.1743-6109.2005.20362.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radiation to the pelvis is associated with erectile dysfunction (ED). The mechanisms include neural injury, vascular alterations, and corporal smooth structural changes. There exists little data on the vascular assessment of men who present with ED following radiation therapy for prostate cancer. This study was conducted to evaluate the erectile hemodynamics in such a patient population. METHODS Men who presented for the evaluation of ED following radiation therapy for prostate cancer underwent vascular evaluation in the form of dynamic infusion cavernosometry and cavernosography (DICC). Established parameters were recorded to define arterial insufficiency and venocclusive function including cavernosal artery occlusion pressure, flow-to-maintain, and pressure decay. RESULTS Sixteen men with a mean age of 61 years presenting with ED after radiation underwent DICC at a mean duration post radiation of 11 months. All of the patients in whom arterial hemodynamics were measurable had abnormal arterial parameters, and 85% had abnormal venocclusive parameters. Of the patients who could undergo cavernosography, 80% had venous leak, most commonly from the crura. CONCLUSIONS Men presenting with ED following radiation therapy for prostate cancer are likely to have significant alterations in erectile hemodynamics, often of a combined arterio-venogenic nature. In patients with venous leak the majority had venocclusive dysfunction with venous leak emanating from the crura.
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Affiliation(s)
- John Mulhall
- Department of Urology, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Nandipati K, Raina R, Agarwal A, Zippe CD. Early combination therapy: intracavernosal injections and sildenafil following radical prostatectomy increases sexual activity and the return of natural erections. Int J Impot Res 2006; 18:446-51. [PMID: 16482200 DOI: 10.1038/sj.ijir.3901448] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Early pharmacological prophylaxis has been reported to increase the return of spontaneous erections following radical prostatectomy (RP). In this study, we evaluated the role of intracavernosal alprostadil (PGE1) combined with sildenafil in stimulating early recovery of spontaneous erections following RP. In this prospective study, we included 22 patients who underwent bilateral nerve-sparing RP after October 2004. Sildenafil dose of 50 mg/day was started at the time of hospital discharge. Of 22 patients, 18 started on PGE1-4 microg (1-8) and four started on low-dose Trimix (20 U) 2-3 times/week. These patients are followed up at regular intervals (3, 6, 9 and 12 months) with abridged version of the International Index for Erectile Function-5 questionnaire. Patient compliance, return of sexual activity and return of natural erection, adverse effects and reasons for discontinuation were recorded. Penile doppler studies were performed during followup visits to assess the vascular status. After a mean followup of 6 months (3-8 months), 11/22 (50%) patients had return of spontaneous partial erections. Of the 18 PGE1 users, six continued 4 microg PGE1, four increased the dose to 8 microg, six decreased the dose to 2 microg and two patients further reduced the dose to 1 microg. Of four low-dose Trimix users, three increased the dose to 30 U and one reduced the dose to 15 U. Of 22 patients, 21 were sexually active: 12/21 (57%) with the injections alone and 9/21 (42.9%) with combination therapy (injections (PGE1) and sildenafil). Penile doppler studies revealed arterial insufficiency in 77% (17/22) patients and venous insufficiency in one patient. Early intracavernosal injections following RP facilitated early sexual intercourse, patient satisfaction and potentially earlier return of natural erections. Early combination therapy with sildenafil allowed a lower dose of intracavernous injections, minimizing the penile discomfort.
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Affiliation(s)
- K Nandipati
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44125, USA.
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Bhatnagar V, Stewart ST, Huynh V, Jorgensen G, Kaplan RM. Estimating the risk of long-term erectile, urinary and bowel symptoms resulting from prostate cancer treatment. Prostate Cancer Prostatic Dis 2006; 9:136-46. [PMID: 16402091 DOI: 10.1038/sj.pcan.4500855] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Reports on long-term complications resulting from treatment for localized prostate cancer are very inconsistent. In order to estimate the risks of long-term erectile dysfunction, urine symptoms and bowel symptoms following prostatectomy (RP), external conventional or conformal beam radiation (ERT or CRT) and brachytherapy (BRT), 98 papers from the PubMed and Cochrane Clinical Trial databases were selected, reviewed and critically evaluated. The majority of papers were institution-based retrospective and prospective follow-up studies; only two of these studies measured the risk of developing more than one treatment complication. Due to differences in study designs and populations, it is difficult to directly compare studies and not meaningful to calculate summary estimates. In addition to focusing on randomized clinical trials and well-designed population based studies, future research should adopt standardized methodologies and should measure the risk of developing more than one treatment complication.
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Affiliation(s)
- V Bhatnagar
- Health Services Research and Development, Center for Patient Oriented Care, Veteran's Affairs San Diego Health Care System, CA, USA.
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Cappelleri JC, Althof SE, Siegel RL, Stecher VJ, Tseng LJ, Duttagupta S. Association between the Erectile Dysfunction Inventory of Treatment Satisfaction and the Self-Esteem and Relationship Questionnaire following treatment with sildenafil citrate for men with erectile dysfunction. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2005; 8 Suppl 1:S54-60. [PMID: 16336489 DOI: 10.1111/j.1524-4733.2005.00072.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Research is lacking on the correlation between treatment satisfaction and confidence, self-esteem, and relationships for men receiving treatment for erectile dysfunction (ED). We sought to correlate scores between the validated Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) index and the validated Self-Esteem And Relationship (SEAR) questionnaire following treatment with sildenafil citrate (VIAGRA). METHODS This study was based on an open-label, flexible-dose trial of 93 sildenafil-naive patients with ED. Pearson correlation coefficients between EDITS index and SEAR questionnaire scores, each of which can range from 0 to 100 (most favorable), were calculated at end of treatment (EOT). An analysis of covariance model was applied to associate changes from baseline to EOT in SEAR scores with EDITS score at EOT, controlling for baseline SEAR score. RESULTS Significant and sizable Pearson's correlations between SEAR and EDITS scores (P < or = 0.0001; range: 0.49-0.84) were observed. A 10-point higher EDITS scores at EOT corresponded to a significant and tangible average improvement in SEAR scores from baseline to EOT (P < or = 0.0001; range: 6.6-8.7). Average SEAR scores at EOT were markedly different between patients with greater treatment satisfaction at EOT (EDITS score > or = median EDITS score of 88.6; n = 50) and those with lesser treatment satisfaction at EOT (EDITS score <88.6; n = 43). CONCLUSIONS The data add to the validity of the SEAR questionnaire, suggest a tangible relationship between treatment satisfaction and psychosocial benefit among men with ED treated with sildenafil, and highlight the importance of assessing the psychosocial impact of ED in men undergoing treatment.
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Finney G, Haynes AM, Cross P, Brenner P, Boyn A, Stricker P. Cross-sectional analysis of sexual function after prostate brachytherapy. Urology 2005; 66:377-81. [PMID: 16098365 DOI: 10.1016/j.urology.2005.03.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Revised: 02/18/2005] [Accepted: 03/18/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess sexual function after prostate brachytherapy and compare outcomes in different age groups. METHODS This cross-sectional study consisted of 96 sexually active patients (mean age 64 years) who underwent iodine-125 seed implantation between 1997 and 2003 to treat early-stage prostate cancer (Stage T1-T2). Patients completed a questionnaire adapted from the validated Rand 36-Item Health Survey and the University of California, Los Angeles, Prostate Cancer Index. RESULTS The median follow-up was 2.5 years (range 3 months to 6.2 years). The mean value for sexual function was 54.8. The mean score for erectile function was 55.0, and the mean score for the ability to reach orgasm was 54.0. No significant relationship was found between sexual function and time since treatment (P = 0.9897). Pain on orgasm was reported after brachytherapy by 38 patients (40%) and hematospermia by 16 patients (17%). A negative correlation was observed between pain on orgasm and time since treatment (P = 0.021), but no significant relationship was found between hematospermia and time since treatment (P = 0.427). A significant difference in sexual function was observed between patients younger than 60 years and patients older than 60 years (66.3 +/- 7.0 versus 47.7 +/- 7.2; P = 0.002). CONCLUSIONS A large variation in sexual potency is present after brachytherapy with no significant relationship to the time since treatment. Age is an indicator of sexual function after brachytherapy, with younger patients experiencing less sexual dysfunction than older patients. Other aspects of sexual function (pain on orgasm, hematospermia) are also significant side effects of brachytherapy and must be considered in the treatment decision for low-risk prostate cancer.
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Affiliation(s)
- Georgina Finney
- Cancer Research Program, Garvan Institute of Medical Research, St. Vincent's Hospital, Darlinghurst, Sydney, New South Wales, Australia
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Mangar SA, Huddart RA, Parker CC, Dearnaley DP, Khoo VS, Horwich A. Technological advances in radiotherapy for the treatment of localised prostate cancer. Eur J Cancer 2005; 41:908-21. [PMID: 15808957 DOI: 10.1016/j.ejca.2004.12.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Accepted: 12/02/2004] [Indexed: 10/25/2022]
Abstract
There is good evidence that radiation dose escalation in localised prostate cancer is associated with increased cell kill. The traditional two-dimensional (2D) technique of treatment planning and delivery is limited by normal tissue toxicity, such that the dose that can be safely delivered to the prostate by external beam radiotherapy is 65-70 Gy. Several technological advances over the last 20 years have enhanced the precision of external beam radiotherapy (EBRT), and have resulted in improved outcomes. The three-dimensional conformal radiotherapy (3D-CRT) approach reduces the dose-limiting late side-effect of proctitis and has allowed for dose escalation to the whole prostate to 78 Gy. More recently, intensity modulated radiotherapy (IMRT), an advanced form of conformal therapy, has resulted in reduced rectal toxicity when using doses greater than 80 Gy. In addition, IMRT can potentially escalate the dose to specific parts of the prostate where there are resistant subpopulations of tumour clonogens, or can be used to extend the high-dose region to pelvic lymph nodes. The addition of androgen deprivation to conventional radiotherapy has an impact on survival and local control. Initial hormone therapy causes cytoreduction of the prostate cancer allowing for a reduction in radiotherapy volume as well as an additive effect on cell kill. Long-term adjuvant androgen deprivation has been shown to improve overall survival in more advanced tumours. Prostate brachytherapy is now a recognised treatment for those with low-risk disease. It achieves similar long-term outcome to other treatment modalities. Brachytherapy can be used as monotherapy for localised disease, or as boost treatment following conventional EBRT for locally advanced disease. New techniques are available to improve the precision of both target definition and treatment verification. This so-called image-guided radiotherapy will help to enhance the accuracy of dose delivery by correcting both for inter-fraction positional variation and for intra-fraction movement of the prostate in real-time and will allow for tighter tumour margins and avoidance of normal tissues, thereby enhancing the safety of treatment.
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Affiliation(s)
- Stephen A Mangar
- Academic Unit of Radiotherapy and Oncology, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5NG, UK.
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Cappelleri JC, Rosen RC. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res 2005; 17:307-19. [PMID: 15875061 DOI: 10.1038/sj.ijir.3901327] [Citation(s) in RCA: 260] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Sexual Health Inventory for Men (SHIM) is a widely used scale for screening and diagnosis of erectile dysfunction (ED) and severity of ED in clinical practice and research. In reviewing the SHIM-related literature, we sought to provide a compendium of studies in which the SHIM was used, to provide a systematic framework for organizing and evaluating the studies, and to provide a status report on the SHIM and its impact on the management of male sexual dysfunction. Using a Medline search, we found that the SHIM was an integral measure in at least 21 studies on the prevalence of ED, 23 studies on the efficacy of ED interventions, and eight other (mainly correlational) studies. The quantity of research and quality of scholarship on the SHIM provide testimony to its positive impact on understanding and improving male sexual function. These scientific contributions are likely to remain influential in coming years.
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Affiliation(s)
- J C Cappelleri
- Pfizer Inc., Global Research and Development, Groton, CT 06340-8030, USA.
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Speight JL, Elkin EP, Pasta DJ, Silva S, Lubeck DP, Carroll PR, Litwin MS. Longitudinal assessment of changes in sexual function and bother in patients treated with external beam radiotherapy or brachytherapy, with and without neoadjuvant androgen ablation: Data from CaPSURE. Int J Radiat Oncol Biol Phys 2004; 60:1066-75. [PMID: 15519776 DOI: 10.1016/j.ijrobp.2004.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Revised: 05/05/2004] [Accepted: 05/10/2004] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effects of external beam radiotherapy (EBRT), with or without brachytherapy (BT) boost or brachytherapy monotherapy with and without short-term androgen ablation (<==6 months; STAD) on sexual function (SF) and sexual bother (SB) in men treated for localized prostate cancer. METHODS AND MATERIALS A total of 992 men with newly diagnosed prostate cancer enrolled in the Cancer of the Prostate Strategic Urological Research Endeavor database were studied to assess treatment-related changes in SF and SB. Six treatment subgroups (EBRT - STAD, EBRT + STAD, BT - STAD, BT + STAD, EBRT + BT - STAD, EBRT + BT + STAD) were compared. RESULTS The greatest reported changes in SF occurred during the first 2 posttreatment years. Patients receiving BT reported greater SF and the least change in SF overall; those receiving EBRT + BT reported the greatest decline in SF. SF scores associated with STAD were initially lower than in patients without STAD; however by 1 year no statistically significant difference in SF or SB was noted. CONCLUSION Each treatment for prostate cancer can negatively affect SF and SB. Initial differences among treatment subgroups exist, but diminish with time. SF changes associated with EBRT +/- BT were statistically significant and those for BT were not. STAD appeared to confer only temporary and recoverable impairment of erectile function.
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Affiliation(s)
- Joycelyn L Speight
- Department of Radiation Oncology, University of California San Francisco/Mt. Zion Comprehensive Cancer Center, San Francisco, CA, USA.
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Mabjeesh N, Chen J, Beri A, Stenger A, Matzkin H. Sexual function after permanent 125I-brachytherapy for prostate cancer. Int J Impot Res 2004; 17:96-101. [PMID: 15510186 DOI: 10.1038/sj.ijir.3901271] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We prospectively assessed patients' erectile function (EF) using the International Index of Erectile Function (IIEF) and a global assessment questionnaire (GAQ) following permanent 125I-brachytherapy for localized prostate cancer. Of 378 treated patients, 220 had a minimal 2-y follow-up and 131/220 were sexually active prior to brachytherapy, with an EF domain score of > or = 11 (study group). Patients were allowed sildenafil at any time of the study. The patients' mean EF score, without excluding patients who used sildenafil, dropped within 3 months after brachytherapy, recovered at the end of the first year and remained unchanged for at least up to 2 y after treatment regardless of the addition of neoadjuvant hormone therapy to 125I-brachytherapy. Analysis of the GAQ revealed that 80% of the patients were satisfied with their sexual function up to 3 y after treatment. Any detrimental effect of permanent brachytherapy with or without the addition of hormone therapy on EF is reversible, and recovery is expected at 1 y after treatment in most patients.
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Affiliation(s)
- N Mabjeesh
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Potosky AL, Davis WW, Hoffman RM, Stanford JL, Stephenson RA, Penson DF, Harlan LC. Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the prostate cancer outcomes study. J Natl Cancer Inst 2004; 96:1358-67. [PMID: 15367568 DOI: 10.1093/jnci/djh259] [Citation(s) in RCA: 431] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Men treated for clinically localized prostate cancer with either radical prostatectomy or external beam radiotherapy usually survive many years with the side effects of these treatments. We present treatment-specific quality-of-life outcomes for prostate cancer patients 5 years after initial diagnosis. METHODS The cohort consisted of men aged 55-74 years who were newly diagnosed with clinically localized prostate cancer in 1994-1995 and were treated with radical prostatectomy (n = 901) or external beam radiotherapy (n = 286). We used clinical and quality-of-life data previously collected at the time of diagnosis (i.e., baseline) and at the 2-year follow-up and data newly collected at 5 years after diagnosis to compare urinary, bowel, and sexual function and to examine temporal changes in those functions. Odds ratios (ORs) and adjusted percentages were calculated by logistic regression. All statistical tests were two-sided. RESULTS At 5 years after diagnosis, overall sexual function declined in both groups to approximately the same level. However, at 5 years after diagnosis, erectile dysfunction was more prevalent in the radical prostatectomy group than in the external beam radiotherapy group (79.3% versus 63.5%; OR = 2.5, 95% confidence interval [CI] = 1.6 to 3.8). Approximately 14%-16% of radical prostatectomy and 4% of external beam radiotherapy patients were incontinent at 5 years (OR = 4.4, 95% CI = 2.2 to 8.6). Bowel urgency and painful hemorrhoids were more common in the external beam radiotherapy group than in the radical prostatectomy group. All of these differences remained statistically significant after adjustment for confounders and for differences between treatment groups in some baseline characteristics. CONCLUSIONS At 5 years after diagnosis, men treated with radical prostatectomy for localized prostate cancer continue to experience worse urinary incontinence than men treated with external beam radiotherapy. However, the two treatment groups were more similar to each other with respect to overall sexual function, mostly because of a continuing decline in erectile function among the external beam radiotherapy patients between years 2 and 5.
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Affiliation(s)
- Arnold L Potosky
- Division of Cancer Control and Population Sciences, National Cancer Institute, EPN Rm. 4005, 6130 Executive Blvd., MSC 7344, Bethesda, MD 20892-7344, USA.
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