To analyze erectile function in men treated by prostate brachytherapy PB for localized prostate cancer. Following PB, the majority of patients progressively develop or major ED after a free interval that may last several months. In Europe as well as in North America, carcinoma of the prostate CaP is the most frequent cancer in men before lung cancer [ 12 ].
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Moreover, its incidence has been increasing during recent decades and continues to rise. Thanks to efforts toward early diagnosis, CaP is mostly diagnosed at an early stage.
Until now, comparison of different treatments according to long-term oncological results has been controversial [ 3 ], putting functional aspects at the forefront in decision counseling. Erectile dysfunction ED is a major preoccupation for CaP patients, especially younger ones.
Sexual function after prostate seed implants meta-analysis of 54 articles concluded that the predicted probability of maintaining erectile function was 0. The latter point is crucial in view of the possibility of delayed deterioration of erectile function following radiation treatments [ 67 ]. However, so far, observations of changes Sexual function after prostate seed implants time of the prevalence of ED after PB remain controversial. The recommendations of the American Brachytherapy Society illustrate this uncertainty, concluding that both severity and duration of morbidities after treatment may vary from one patient to another [ 11 ].
The primary goal of the present study was to analyze the occurrence of ED after PB and its associated risk factors in a series of sexually active men treated by permanent I brachytherapy.
How Are Radiation Therapy and...
Between andconsecutive patients were implanted with radioactive iodine I seeds using a real-time ultrasound-based planning technique real-time computer-assisted dosimetry with dynamic seed localization performed in the operating room. The prescribed brachytherapy dose was No patient received supplemental external beam radiation therapy or surgery potentially damaging to erectile function. A questionnaire on sexual activity including the IIEF-5 questionnaire was systematically completed by the patients before the beginning of treatment during the preimplant consult.
We performed our survey of sexual dysfunction in November All patients who were sexually active before PB were contacted by mail irrespectively of whether or not they had a committed partner. An introductory letter was mailed to the patients that included the questionnaire, the name of the research contact person and phone numbers for further information. Evaluations were completed by mail and a reminder letter was sent if questionnaires were not returned within four weeks. Anyway, each
Sexual function after prostate seed implants completed only one post-treatment questionnaire.
The implanted seeds in brachytherapy...
Of the patients, 28 men who were not sexually active before PB, eight who needed a second implantation and 10 who had died of causes unrelated to cancer were excluded. After treatment, the eligible patients were asked to participate in the survey of sexual dysfunction and were considered as agreeing to participate if they completed the questionnaire.
Only 29 refused to take part participation rate: Finally, we obtained information about sexual function before and after PB in patients. Sociodemographic data, disease and treatment characteristics were recorded prospectively.
The questionnaire on sexual function covered various aspects of sexual activity. Here we present only the results relating to erectile function. The questionnaire was similar
Sexual function after prostate seed implants the pre-treatment inventory of sexual function in order to be able to compare changes over time.
In order not to bias the results due to the use of medications notably PDE5 inhibitorsit was stressed in the introduction letter and in the questionnaire that the patients had to describe the quality of erection without any medication, and a special question focused on treatment for sexual dysfunction. According to the recommendations of the American Brachytherapy Society [ 11 ], erectile function was assessed using the IIEF-5 questionnaire French version [ 12 ].
To analyze the severity of ED, we used the accepted classes: Descriptive statistics were performed for all studied variables with a normality test for all
Sexual function after prostate seed implants variables.
Inter-group comparisons were performed using the chi-2 or Fisher exact test for qualitative variables and the Mann—Whitney test for quantitative variables. As there were a large number of variables, we first performed factorial analysis to obtain a graphic representation to reveal potential interactions between variables. ED risk factors were studied by logistic regression analysis with adjustment for age, neoadjuvant androgen deprivation therapy and PSA level.
The log-rank test was used for inter-group comparisons. Cox regression was applied to determine the links between variables and occurrence over time of ED hazard ratiowhen the proportional hazards hypothesis was verified. In accordance with French regulations about clinical research, it was not required to have agreement from an ethics committee for such an observational study of a validated treatment. After implantation, patients had a significantly lower mean IIEF score than before implantation The results of logistic regression were adjusted for age, neoadjuvant androgen deprivation therapy and PSA level.
Univariate analysis was performed for the following variables: It was noteworthy that the risk of developing ED appeared to increase with decreasing prostate volume. Significant risk factors for erectile dysfunction after prostate brachytheray in univariate analysis. Risk factors for erectile dysfunction after prostate brachytherapy in multivariate analysis. With regard to the timing of
Sexual function after prostate seed implants of ED, we carried out separate analysis of patients who had received neoadjuvant androgen deprivation therapy.
Their time to onset of ED was significantly shorter 3 vs. In patients who had not had neoadjuvant androgen deprivation therapy, were able to estimate the time to onset of their ED, 30 replied that they had experienced no deterioration and 6 patients were unable to state when erectile function had deteriorated.
One of the aims of our study was to clarify the risk of ED after brachytherapy in order to provide patients with fuller information. However, several remarks may be made: This results in a lack of sensitivity, since decreases of the IIEF score above 12 were not taken into account.
Another drawback to using reasoning based on a fixed score, rather than in terms of a downgrade in class, is that this makes evaluation dependent on erectile function before treatment.
It is therefore difficult to draw from this study conclusion applicable to the general population of patients treated by brachytherapy. In a recent study of Merrick team, in the patients with prostate cancer and preimplant erectile function assessed by IIEF6, the 7-year actuarial rate potency preservation was Potent patients were statistically younger, had higher preimplant IIEF and were less likely to be diabetic [ 15 ].
Potency preservation and median IIEF scores following brachytherapy
Sexual function after prostate seed implants durable. Thoughtful dose sparing of proximal penile structures and early penile rehabilitation may further improve these results [ 15 ]. The present results concern erectile function without any medication, but Schiff et al. These results plead for the development of interventions for a better management of ED in this population [ 17 ].
Patients at high risk of ED should be particularly concerned by such interventions. We identified 3 risk factors for ED: Prostate volume was the third significant factor in the multivariate analysis. The patients with a small prostate volume had a high risk of severe ED post PB, independent of the brachytherapy parameters. In
Sexual function after prostate seed implants experience, the imaging technique used to calculate prostate volume MRI for the patients treated in Toulouse does not seem to modify significantly the performance of the model.
Several anatomic structures involved in erectile function may be affected by PB in the case of a small prostate gland, due to an increase risk of radiation outside of the prostate. Diabetic patients and those treated by neoadjuvant androgen deprivation should also be implicated as they developed early ED.
Other factors that could be involved in ED after PB were not explored by the present study: There is no doubt
Sexual function after prostate seed implants such fears could be alleviated by appropriate information.
Moreover, we recently showed that PB resulted in ejaculatory and orgasmic troubles [ 18 ]. Taking into account the high prevalence of sexual dysfunction in patients treated by PB, we propose developing supportive interventions in the domain of sexuality to cover the whole pre-treatment and post-treatment period [ 19 ].
This is a cohort study and consequently may differ from the overall population of patients treated by PB. However, the criteria of patient inclusion and the treatment modalities used in our centre are widely accepted.
Participation rate was high and we verified that participants and men who declined to participate did not differ according to demographic, disease and treatment variables.
We do not therefore think that this might be a source of bias. We cannot rule out the risk of miscalculation related
Sexual function after prostate seed implants evaluation by the patient of the date when erectile function began to deteriorate. However, most of the questionnaire uses a validated scale IIEF-5which limits the risk of bias. There was only one evaluation of erectile
Sexual function after prostate seed implants after PB.
This is a shortcoming to study evolution of erectile function in time. Factorial analysis showed that an IIEF score of less than 7 after brachytherapy was related to the presence of concurrent disorders: However, in multivariate analysis, only age, IIEF score before implantation and prostate volume were found to be significant.
Other studies with larger series are certainly required to provide more precise knowledge of risk factors for ED after brachytherapy. Our evaluation does not take several items into account, such as age of partner or frequency of intercourse. We project to develop a prospective study including these shortcomings for further understanding of this important health related quality of life issue.
Patients often choose brachytherapy because it is reputed to be less damaging to erectile function. In view of the high prevalence
Sexual function after prostate seed implants ED after PB, information before treatment about this morbidity of PB is mandatory, especially in patients at high risk of developing ED age over 65, preimplant ED and small prostate volume.
Adequate management of ED after treatment should be proposed to patients who wish to maintain sexual function. Nina Crowte for her precious help. Work supported by the Ligue Nationale contre le Cancer, France.
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All authors read and approved the final manuscript. Patrice Njomnang Soh, Email: Jean Marc Bachaud, Email: National Center for Biotechnology InformationU. Journal List Basic Clin Androl v. Published online Aug Author information Article notes Copyright and License information Disclaimer. Received May 3; Accepted Jun This article is published under license to BioMed Central Ltd. This article has been cited by other articles in PMC. Abstract Background and purpose To analyze erectile function in
Sexual function after prostate seed implants treated by prostate brachytherapy PB for localized prostate cancer.
But with prostate cancer, the potential side effects can be particularly Following surgery, many men experience erectile dysfunction (ED), but for types of radiation therapy—brachytherapy, external beam radiation or vacuum erection device, or surgery may be performed to implant a penile prosthesis. The implanted seeds in brachytherapy are placed to hopefully avoid the experience erectile dysfunction following low-dose brachytherapy.
Recovery of erectile function after a used, such as radioactive seed implants.
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