Longitudinal comparison of sexual function after 3-dimensional conformal radiation therapy or prostate brachytherapy.
OBJECTIVE
The risk of erectile dysfunction can influence treatment decisions for localized prostate cancer. To estimate the risk from 2 popular radiotherapies we compared erectile function and overall satisfaction with sexual function after 3-dimensional (D) conformal radiation therapy and transperineal prostate brachytherapy.


METHODS
A total of 128 patients with prostate cancer underwent 3-D conformal radiation therapy (median dose 70.2 Gy. to the planning target volume) and 60 underwent palladium transperineal prostate brachytherapy (median dose 90 or 115 Gy. to 80% of the prostate with or without external nonconformal beam radiation therapy. Of the 128 patients 47 (37%) also received a luteinizing hormone releasing hormone (LH-RH) agonist (3 to 4 months), whereas 26 (43%) of the 60 patients received external beam radiation therapy and LH-RH (8 to 9 months). We evaluated erectile function and overall satisfaction with questions from validated, self-administered questionnaires. Patients responded to the questions serially before any prostate cancer therapy and at regular followup visits thereafter. We used the time until a patient returned to baseline erectile function and overall satisfaction to compare treatment modalities.


RESULTS
Median followup was 21 months. Of patients receiving 3-D conformal radiation therapy with or without LH-RH agonists 65% (95% CI 47% to 82%) and 67% (53% to 81%), respectively, returned to baseline overall satisfaction within 12 months after treatment versus 23% (9% to 50%) and 56% (38% to 75%) of the patients treated with transperineal prostate brachytherapy with or without external beam radiation therapy and LH-RH agonists, respectively. Reductions in overall satisfaction appeared to relate to changes in erectile function.


CONCLUSIONS
These data suggest that in the absence of LH-RH agonist use 3-D conformal radiation therapy and transperineal prostate brachytherapy have a similar impact on erectile function and overall satisfaction. Differences observed in erectile function and overall satisfaction in the 2 groups of patients who received adjuvant LH-RH may be due to the different duration of therapy (3 versus 8 months). Longer followup will be needed to evaluate this hypothesis.
Valicenti
Richard K
RK
Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Bissonette
Eric A
EA
Chen
Chris
C
Theodorescu
Dan
D
D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D007172:Erectile Dysfunction / Q000209:etiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010165:Palladium / Q000627:therapeutic use; D017060:Patient Satisfaction; D010410:Penile Erection / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use; D020266:Radiotherapy, Conformal / Q000009:adverse effects
D011868:Radioisotopes; D010165:Palladium