Penile erectile function after permanent radioactive seed implantation for treatment of prostate cancer.

PURPOSE We assess erectile function after prostate brachytherapy and analyze those factors affecting potency preservation. MATERIALS AND METHODS A total of 416 patients treated from October 1990 to September 1998 with permanent radioactive seed implantation for T1 to T2 prostate cancer had erectile function assessed before and after treatment. Erectile function was assessed using the scoring system of 0-complete inability to have erections, 1-able to have erections but insufficient for intercourse, 2-can have erections sufficient for intercourse but considered suboptimal and 3-has normal erectile function. Implant dose was defined as the D90, which was the dose delivered to 90% of the gland on a dose volume histogram from the 1-month computerized tomography based dosimetric analysis. RESULTS Pretreatment erectile function assessment revealed scores of 0 in 57 (14%), 1 in 46 (11%), 2 in 77 (18%) and 3 in 236 (57%) patients. In 313 patients who were potent with a score 2 or greater before therapy the actuarial freedom from any decrease in erectile function score was 64% and 30% at 3 and 6 years, respectively. The actuarial preservation of potency, with a score 2 or greater, was 79% and 59% at 3 and 6 years, respectively. The 2 factors found to have a significant negative effect on potency in univariate and multivariate analyses were high implant dose (D90 greater than 160 Gy. for I-125 and D90 greater than 100 Gy. for Pd-103) and a pretreatment erectile function score of 2 versus 3. CONCLUSIONS The rate of potency preservation after brachytherapy is high, although a decrease occurs from 3 to 6 years. Pretreatment erectile dysfunction as well as higher implant dose are associated with greater impotency.

[1]  R A Stephenson,et al.  Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. , 2000, JAMA.

[2]  M. Zelefsky,et al.  Long term tolerance of high dose three‐dimensional conformal radiotherapy in patients with localized prostate carcinoma , 1999, Cancer.

[3]  Michael J. Zelefsky,et al.  Comparison of the 5-Year Outcome and Morbidity of Three-Dimensional Conformal Radiotherapy Versus Transperineal Permanent Iodine-125 Implantation for Early-Stage Prostatic Cancer , 1999 .

[4]  R. Stock,et al.  A dose-response study for I-125 prostate implants. , 1998, International journal of radiation oncology, biology, physics.

[5]  R. Weichselbaum,et al.  Potency probability following conformal megavoltage radiotherapy using conventional doses for localized prostate cancer. , 1997, International journal of radiation oncology, biology, physics.

[6]  W Cavanagh,et al.  Should brachytherapy be considered a therapeutic option in localized prostate cancer? , 1996, The Urologic clinics of North America.

[7]  K. Wallner,et al.  103Pd brachytherapy and external beam irradiation for clinically localized, high-risk prostatic carcinoma. , 1996, International journal of radiation oncology, biology, physics.

[8]  P. Unger,et al.  Prostate specific antigen findings and biopsy results following interactive ultrasound guided transperineal brachytherapy for early stage prostate carcinoma , 1996, Cancer.

[9]  R. Stock,et al.  Sexual potency following interactive ultrasound-guided brachytherapy for prostate cancer. , 1996, International journal of radiation oncology, biology, physics.

[10]  J Roy,et al.  Tumor control and morbidity following transperineal iodine 125 implantation for stage T1/T2 prostatic carcinoma. , 1996, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  M. Roach,et al.  Potency following high-dose three-dimensional conformal radiotherapy and the impact of prior major urologic surgical procedures in patients treated for prostate cancer. , 1995, International journal of radiation oncology, biology, physics.

[12]  P. Unger,et al.  Laparoscopic pelvic lymph node dissection combined with real-time interactive transrectal ultrasound guided transperineal radioactive seed implantation of the prostate. , 1995, The Journal of urology.

[13]  J. Adolfsson,et al.  Decreased sexual capacity after external radiation therapy for prostate cancer impairs quality of life. , 1995, International journal of radiation oncology, biology, physics.

[14]  R. Stock,et al.  A modified technique allowing interactive ultrasound-guided three-dimensional transperineal prostate implantation. , 1995, International journal of radiation oncology, biology, physics.

[15]  L. Anderson,et al.  Dosimetry of interstitial brachytherapy sources: Recommendations of the AAPM Radiation Therapy Committee Task Group No. 43 , 1995 .

[16]  E. Messing,et al.  Sequelae of definitive radiation therapy for prostate cancer localized to the pelvis. , 1994, Urology.

[17]  F. L. Banker.  The preservation of potency after external beam irradiation for prostate cancer. , 1988, International journal of radiation oncology, biology, physics.

[18]  W. Catalona,et al.  Nerve-sparing radical prostatectomy: extraprostatic tumor extension and preservation of erectile function. , 1985, The Journal of urology.

[19]  I. Goldstein,et al.  Radiation-associated impotence. A clinical study of its mechanism. , 1984, JAMA.

[20]  M. Zelefsky,et al.  Elucidating the etiology of erectile dysfunction after definitive therapy for prostatic cancer. , 1998, International journal of radiation oncology, biology, physics.

[21]  H A Feldman,et al.  Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. , 1994, The Journal of urology.