OC-0051 Quality of Life After Radical Radiotherapy for Prostate Cancer: Results from a Randomised Trial of Ebrt ± HDR-BT (original) (raw)
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Erectile function and quality of life after interstitial radiation therapy for prostate cancer
International Journal of Impotence Research, 2000
Few studies have evaluated erectile function after interstitial radiation therapy for localized prostate cancer. Using a validated quality of life questionnaire, we assessed post-treatment erectile function and its relationship to treatment satisfaction and quality of life. We retrospectively reviewed the records of 171 consecutive patients who underwent Pd-103 or I-125 brachytherapy for prostate cancer between December 1992 and June 1998. Seventy percent of patients received neoadjuvant androgen deprivation therapy. All patients were mailed a validated questionnaire assessing sexual function and overall quality of life (UCLA Prostate Cancer Index and SF-36). Sixty-seven percent of all questionnaires were available for evaluation (114a171). The mean age was 69.1 y with a mean follow-up of 23 months (range 4 ± 72, median 24). Seventy-one percent of patients (81a114) had pre-treatment erections suf®cient for sustained vaginal penetration. Of these patients, potency was maintained in 49% of men (40a81). An additional 26% had erections ®rm enough for foreplay but not penetration (21a81). Erectile dysfunction rates were signi®cantly lower in younger patients (48%) vs older patients (55%). There was no difference in post-treatment potency between men who received neoadjuvant hormonal therapy and those who did not (P b 0.05). In addition, there were no differences in physical function (86, scale 0 ± 100), general health perception (78), emotional well-being (83), energyafatigue (74), and overall satisfaction (84) between men with erectile dysfunction and those without.
Erectile Function Outcome Reporting After Clinically Localized Prostate Cancer Treatment
Journal of Urology, 2007
were done to derive outcome reporting (efficacy or side effects) for the treatment of clinical stage T1 or T2 N0M0 prostate cancer. A database was constructed containing descriptions relating to erectile function as well as numerical frequency rates of complete erectile dysfunction, and partial and intact erectile function for various treatments. A literature review was also done, consisting of a PubMed Services search of current measures and protocols used for assessing erectile function outcomes and a survey of consensus opinion sources on the management of male sexual dysfunctions. Results: Based on inclusion criteria 436 articles were selected. Of these articles database extraction from 100 pertaining to radical prostatectomy garnered various characterizations of erectile function, including qualitative descriptions, generic terminology and rating systems. Database extraction from 31 articles, in which results for at least 50 patients were reported, yielded ranges of rates for complete erectile dysfunction, partial erectile function and intact erectile function that were 26% to 100%, 16% to 48% and 9% to 86% for radical prostatectomy, 8% to 85%, 21% to 47% and 36% to 63% for external beam radiation, and 14% to 61%, 21% and 18% for interstitial radiation, respectively. The literature review showed an evolution in standards for studying and reporting erectile function outcomes. Conclusions: Clinical studies reporting erectile function outcomes after localized prostate cancer treatment often demonstrate poorly interpretable and inconsistent manners of assessment as well as widely disparate rates of erectile dysfunction and erectile function. Future studies must apply scientifically rigorous methodology and standard outcomes measures to advance this field of study.
Erectile Dysfunction After External Beam Radiotherapy for Prostate Cancer
European Urology, 2009
Background: There is a lack of prospective studies focusing on the sexual quality of life of prostate cancer patients after conformal radiotherapy (RT). Objective: To evaluate the incidence, progression, and predictive factors for erectile dysfunction (ED). Design, Setting and Participants: Patients who responded to the sexual domain of the Expanded Prostate Cancer Index Composite (EPIC) questionnaire before and more than 1 yr after RT and never received an antiandrogen treatment were included (n = 123). Intervention: RT dose was 70.2-72Gy. Eleven patients used a phosphodiesterase-5 (PDE-5) inhibitor. Measurements: Patients responded to the EPIC questionnaire before (time A), at the last day (B), a median time of 2 mo after (C), and 16 mo after (D) RT. In a multivariate analysis, risk factors (patient age, prostate volume, planning target volume, use of PDE-5 inhibitor, comorbidities) were tested for their independent effects on ED before and after RT. Results and Limitations: Sexual function and bother scores had already decreased by the end of RT (median function and bother scores at times A/B/C/D: 41/30/32/24 and 75/50/50/50). Initial function scores correlated well with late function scores (r = 0.7; p < 0.001). The ability to have an erection was reported by 81%/72%/74%/60% (preserved erectile ability in 70% at time D), erections firm enough for sexual intercourse by 44%/33%/35%/27% (preserved erections sufficient for intercourse in 53% at time D) of patients. A higher patient age and diabetes were predictive of both a pre-existing ED and a post-RT acquired ED. Nightly erections before treatment proved prognostically favourable (at least weekly vs. < weekly-hazard ratio of 5.9 for preserved erections sufficient for intercourse; p = 0.01). Higher rates of ED can be expected with longer follow-up. Conclusions: The incidence of ED progressively increases after RT. Patient age and diabetes are risk factors for both pre-treatment and RT-associated ED. Nightly erections before RT proved prognostically favourable.
Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma
International Journal of Radiation Oncology*Biology*Physics, 2002
Purpose: The results of a 1997 meta-analysis of the rates of erectile function after external beam radiotherapy (EBRT) and radical prostatectomy have been widely used in patient and professional education materials and as a reference against which new findings are compared. With a number of recent publications, it is now possible to update this analysis and compare brachytherapy with or without EBRT with EBRT alone, standard and nerve-sparing radical prostatectomy, and cryotherapy. Methods: A comprehensive literature review and subsequent meta-analysis of the rates of erectile dysfunction associated with the treatments of localized prostate carcinoma was conducted. A simple logistic regression analysis was used to combine the data from the 54 articles that met the selection criteria. Results: The predicted probability of maintaining erectile function after brachytherapy was 0.76, after brachytherapy plus EBRT 0.60, after EBRT 0.55, after nerve-sparing radical prostatectomy 0.34, after standard radical prostatectomy 0.25, and after cryotherapy 0.13. When only studies reporting >2 years follow-up were considered, the only significant change was a decline in the probability for nerve-sparing radical prostatectomy. No brachytherapy studies had a follow-up of >2 years. When the probabilities were adjusted for age, the spread between the RT methods and surgical approaches was greater. Conclusion: The differences in the probability of maintaining erectile function after different treatments of localized prostate cancer are significant.
Brachytherapy, 2014
PURPOSE: To compare erectile dysfunction (ED) after adaptive dose-escalated image-guided intensity-modulated radiotherapy (IG-IMRT) and high-dose-rate interstitial brachytherapy (HDR) monotherapy. METHODS AND MATERIALS: Low-and intermediate-risk prostate cancer patients treated with IG-IMRT or HDR were matched on pretreatment ED, age, Gleason score, T-stage, and prostate specific antigen. Patients who received androgen deprivation therapy were excluded. ED was graded by Common Terminology Criteria for Adverse Events v4. Actuarial rates of ED were computed by the KaplaneMeier method. RESULTS: There were 384 patients with median followup of 2.0 years (0.5e6.1) for IG-IMRT and 2.0 years (0.5e8.7) for HDR. The median IG-IMRT dose was 75.6 Gy and HDR dose 38 Gy in four fractions. For patients with no pretreatment ED, actuarial rates of requiring intervention (Grade 2ED)at3yearswere312 ED) at 3 years were 31% for IG-IMRT and 19% for HDR ( p 5 0.23), and impotence despite medical intervention (Grade 3) were 0% for IG-IMRT and 6% for HDR ( p 5 0.06). For patients with Grade 1 pretreatment ED, Grade 2ED)at3yearswere312 ED at 3 years were 47% for IG-IMRT and 34% for HDR ( p 5 0.79), and Grade 3 ED were 15% in both groups ( p 5 0.59). For patients with Grade 2 pretreatment ED, Grade 3 ED at 3 years were 22% for IG-IMRT and 37% for HDR ( p 5 0.70). No variables were predictive of Grade $2 ED following treatment. CONCLUSIONS: Rates of ED requiring medical intervention for both IG-IMRT and HDR are low and equivalent. Even patients with ED before treatment are likely to maintain potency with medication use at 3 years following treatment. Ó
International Journal of Radiation Oncology*Biology*Physics, 2004
Purpose/Objective: In this study, we evaluated in a serial manner whether radiation dose to the bulb of the penis is predictive of erectile dysfunction, ejaculatory difficulty (EJ), and overall satisfaction with sex life (quality of life) by using serial validated self-administered questionnaires. Methods and Materials: Twenty-nine potent men with AJCC Stage II prostate cancer treated with threedimensional conformal radiation therapy alone to a median dose 72.0 Gy (range: 66.6 -79.2 Gy) were evaluated by determining the doses received by the penile bulb. The penile bulb was delineated volumetrically, and the dose-volume histogram was obtained on each patient. Results: The median follow-up time was 35 months (range, 16 -43 months). We found that for D 30 , D 45 , D 60 , and D 75 (doses to a percent volume of PB: 30%, 45%, 60%, and 75%), higher than the corresponding median dose (defined as high-dose group) correlated with an increased risk of impotence (erectile dysfunction firmness score ؍ 0) (odds ratio [OR] ؍ 7.5, p ؍ 0.02; OR ؍ 7.5, p ؍ 0.02; OR ؍ 8.6, p ؍ 0.008; and OR ؍ 6.9, p ؍ 0.015, respectively). Similarly, for EJD D 30 , D 45 , D 60 , and D 75 , doses higher than the corresponding median ones correlated with worsening ejaculatory function score (EJ ؍ 0 or 1) (OR ؍ 8, p ؍ 0.013; OR ؍ 8, p ؍ 0.013; OR ؍ 9.2, p ؍ 0.015; and OR ؍ 8, p ؍ 0.026, respectively). For quality of life, low (<median dose) dose groups of patients improve over time, whereas high-dose groups of patients worsen. Conclusions: This study supports the existence of a penile bulb dose-volume relationship underlying the development of radiation-induced erectile dysfunction. Our data may guide the use of inverse treatment planning to maximize the probability of maintaining sexual potency after radiation therapy.
Clinical and Translational Radiation Oncology, 2018
Background: Erectile dysfunction is a common side effect of prostate cancer (PC) therapy. In this randomized study (The RIC-study) we used patient reported outcomes to evaluate sexual function 18 months after combined endocrine therapy and radical radiotherapy (RT) given with either wide or tight planning target volume (PTV) margins. We also analyzed the impact of radiation dose to penile bulb on sexual function. Methods: The RIC-study included 257 men with intermediate and high-risk PC. All patients received 6 months of total androgen blockage started 3 months prior to randomization. In high-risk patients, an oral anti-androgen (Bicalutamide) was administered for an additional 2.5 years. Patients were randomized to receive 78 Gy in 39 fractions guided either by weekly offline orthogonal portal imaging or by daily online cone beam computed tomography image-guided RT. Sexual function was evaluated at 18 months after start of RT using the Questionnaire Umeå Fransson Widmark 1994. Ability to have an erection was assessed on an 11-point scale numerical rating scale (0 = no and 10 = very much) as the primary outcome. In addition, the association between penile bulb (PB) radiation dose and erectile function was analyzed. Findings: Of 250 evaluable patients, 228 (mean age 71.8 years) returned the questionnaires. The patients reported a high degree of sexual related problems with mean scores to the primary outcome question (221 respondents) of 7.44 and 7.39 in the 2D weekly IGRT-arm and 3D daily IGRT-arm (p = 0.93) respectively. For four additional questions (scale 0-10) regarding sexual function resulted in mean scores >6.5 with no difference between study arms. The mean dose to PB was substantially larger in the 2D weekly IGRT-arm vs the 3D daily IGRT-arm (mean 59.8 Gy vs mean 35.1 Gy). We found no effect of mean PB-dose on the primary outcome adjusted for study-site, risk-group and age. When adjusting for serum-testosterone level at 18 months in addition, the effect of mean PB-dose remained insignificant. Interpretation: IGRT protocol or PB dose had no effect on ED 18 months after RT in this study population. The low potency rates can partly be explained by the prolonged use of anti-androgen in high risk patients. Longer follow-up is needed to confirm the results from the RIC-study.