Potency after permanent prostate brachytherapy for localized prostate cancer.
OBJECTIVE
The evaluation of potency preservation after treatment of localized prostate cancer with transperineal permanent prostate brachytherapy (PPB) and the efficacy of sildenafil were studied.


METHODS
This study comprised 482 patients who were able to maintain an erection suitable for intercourse before treatment from a cohort of 1166 patients with clinically localized prostate cancer treated with PPB. All patients have been followed prospectively, and actuarial analysis was performed to assess potency preservation over time. Patients treated with sildenafil were evaluated as to its efficacy.


RESULTS
The median follow-up of this cohort was 34 months (6--92), with a median age of 68 years (47--80). Potency was preserved in 311 of the 482 patients, with a 5-year actuarial potency rate of 52.7%. The 5-year actuarial potency rate for patients treated with PPB as monotherapy was 76%, and, for those treated with combination external beam radiotherapy (EBT) + PPB, 56% (p = 0.08). Patients treated with neoadjuvant androgen deprivation (NAAD) + PPB had a 5-year potency rate of 52%, whereas those with combination EBT + PPB + NAAD had a potency rate of 29% (p = 0.13). Cox regression analysis identified that pretreatment use of NAAD and patient age predicted for impotence (p = 0.0001 and 0.04, respectively). Of 84 patients treated with sildenafil, 52 had a successful outcome (62%). The response to sildenafil was significantly better in those patients not treated with NAAD (p = 0.04).


CONCLUSIONS
The actuarial potency rates at 5 years for patients treated with PPB are lower than generally acknowledged, except for those patients treated with PPB as monotherapy. Patients who received sildenafil exhibited improved potency in a majority of cases.
Potters
L
L
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center at Mercy Medical Center, Rockville Center, NY 11570, USA. PottersL@mskcc.org
Torre
T
T
Fearn
P A
PA
Leibel
S A
SA
Kattan
M W
MW
D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods / Q000523:psychology; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015986:Confounding Factors, Epidemiologic; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009518:New York / Q000453:epidemiology; D010879:Piperazines / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy*; D011687:Purines; D011788:Quality of Life; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D000068677:Sildenafil Citrate; D013450:Sulfones; D014657:Vasculitis / Q000150:complications / Q000453:epidemiology
D018931:Antineoplastic Agents, Hormonal; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate