Assessment of Post-Brachytherapy Sexual Function: A Comparison of the IIEF-5 and the MSEFS

Abstract

Purpose/Objective: Erectile dysfunction (ED) remains an undesirable side effect in many men following treatment for prostate cancer. To overcome physician bias in assessment of potency following treatment, patient-assessed validated questionnaires were developed. The Mount Sinai Erectile Function Score (MSEFS) (a physician-assigned potency rating) was developed for our brachytherapy program starting in 1990 (J. Urol., 165: 436–439, 2001). In 2000, patients were asked to independently fill out the International Index of Erectile Function-5 (IIEF-5), also known as the Sexual Health Inventory for Men (SHIM), as part of their evaluation and follow-up. This study compares the two methods of assessment and describes potency following brachytherapy. Materials/Methods: Between 1990 and 2004, 1,202 patients with T1,T2, or T3 prostate cancer were treated with ultrasound-guided radioactive seed implantation with or without external beam irradiation and had a least one visit where both MSEFS and IIEF-5 assessment were completed. At each of the 3,161 visits, patients were assigned a MSEFS ranging from 0 to 3 (0-no erections, 1-ability to have erections but insufficient for vaginal penetration, 2-erectile function sufficient for vaginal penetration but suboptimal, 3-normal erectile function) and completed an IIEF-5 with a possible maximum total score of 25 (severe ED (1–7), moderate ED (8–11), mild to moderate ED (12–16), mild ED (17–21), no ED (22–25). Correlations were performed using the Spearman rho test. Follow-up visits were done at 6-month intervals, ranging from none to 165 months, median 36 months. Results: The MSEFS significantly correlated with the total IIEF-5 scores on all comparisons with p values <0.001. The coefficient was 0.65 for comparisons done on the initial consultation date and 0.76 for all visits. On subsequent follow up visits, the correlations remained strong. The correlation coefficients for follow-up visits 1 through 10 were: 0.76, 0.74, 0.74, 0.78, 0.77, 0.78, 0.79, 0.78, 0.92 and 0.87, respectively. 116 patients were assigned to be potent (MSEFS of 2 or 3) before brachytherapy. Of the 116, we have follow-up on 78; 53 of these patients (68%) remained potent as defined by a MSEFS score of 2 or 3 at last visit. The corresponding last IIEF-5 scores for these patients were: 1–7 in 33%, 8–11 in 9%, 12–16 in 23%, 17–21 in 21% and 22–25 in 14%. Conclusions: Our physician-assigned potency scale correlates well with the IIEF-5. Because the IIEF-5 is weighted considerably toward a patient’s degree of sexual desire, it cannot fully replace, the physician scale in assessing the development of ED after radiation. Furthermore, more insight into patient’s erectile function after brachytherapy may be gotten if the IIEF–15, from which the IIEF-5 was developed, is used instead of the IIEF-5, in conjunction with our MSEFS.