The effect on erectile function of 103palladium implantation for localized prostate cancer.
OBJECTIVE
To determine in a prospective study the effect on erectile function of (103)Pd brachytherapy for localized prostate cancer, using a validated questionnaire.


METHODS
Between July 1999 and April 2003, 113 men with localized prostate cancer were treated by permanent implantation of (103)Pd seeds, of whom 78 with a follow-up of 30 months were included in this study. No patient received supplemental external beam radiation therapy. At baseline and 3-month intervals, erectile function (EF) was assessed by the EF domain score of the International Index of Erectile Function-15 (IIEF-15); 77% received (neo)adjuvant antiandrogen therapy for up to 3 months.


RESULTS
At baseline, 27 (35%) patients had no erectile dysfunction (ED; EF domain score 26-30), 24 (31%) had mild/moderate ED (score 11-25) and 27 (35%) severe ED (score 6-10). The mean EF domain score decreased from 17 to 12 (P < 0.001) after 30 months. Overall, 52 men (67%, including those with severe ED at baseline) remained in the same ED category at 30 months after therapy as before, 12 (15%) deteriorated by one category, 14 (18%) by two or more, and no patient improved. Of the 27 patients fully potent (score 26-30) at baseline, 37% remained so after 30 months, 19% developed mild and the remaining 44% moderate/severe ED. In a multivariate analysis, neither age nor preoperative prostate-specific antigen level, prostate volume, D90, hormonal treatment, diabetes, smoking or hypertension were predictive of preserving potency (P > 0.05).


CONCLUSIONS
There was a high prevalence of pre-existing ED in these men; 57% of men fully potent or with mild ED at baseline remained so 30 months after brachytherapy.
Ponholzer
Anton
A
Department of Urology and Andrology, Ludwig Boltzmann Institute for Urological Oncology, Vienna, Austria.
Oismüller
Renée
R
Somay
Canatay
C
Büchler
Felix
F
Maier
Ulrich
U
Hawliczek
Robert
R
Rauchenwald
Michael
M
Madersbacher
Stephan
S
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects*; D007172:Erectile Dysfunction / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010165:Palladium / Q000627:therapeutic use*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use*
D011868:Radioisotopes; D010165:Palladium