MP76-20 PROSPECTIVE LONG-TERM OUTCOME OF ERECTILE FUNCTION IN MEN TREATED BY PROSTATE BRACHYTHERAPY

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy I1 Apr 2016MP76-20 PROSPECTIVE LONG-TERM OUTCOME OF ERECTILE FUNCTION IN MEN TREATED BY PROSTATE BRACHYTHERAPY Richard Stock and Nelson Stone Richard StockRichard Stock More articles by this author and Nelson StoneNelson Stone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1871AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer patients receiving brachytherapy are known to have a decline in erectile function (EF) long after treatment. We prospectively assessed EF in a cohort of men managed by prostate seed implant and followed a minimum of 5 years. METHODS 1754 men with a median age of 66 years (IQ 61-71) were followed a mean of 10 years (median 9.5, range 5-22) after treatment. Patients received implant alone or implant plus HT or external beam radiotherapy (EBRT) or implant plus HT plus EBRT by risk group. EF was prospectively assessed by the 4 point Mount Sinai Sexual Function Inventory (MSSFI, 0-no EF, 1-EF inadequate for penetration, 2-penetration possible but suboptimal EF and 3-normal EF) and by the 25 point SHIM. The SHIM was grouped into 4 categories- 1-7, no EF, 8-11 minimal to moderate EF, 12-16 moderate EF and 17-25 normal EF. Baseline (pre-implant) scores were compared to 2 and 5 year and last evaluation scores. Independent variables included age (<60, 60-<70, 70+), radiation dose, hormone therapy (HT: 53.5%, median 6 months), testosterone level (T) and pre-treatment function. Associations were compared by ANOVA and Chi-square. Survival function was estimated by Kaplan Meier (KM) method with comparisons by log rank and cox regression proportion hazard rates (HR). RESULTS Of the 1709 (97.4%) with MSSFI 340 (19.9%) had a score of 2 and 886 (51.8%) a score of 3 (total with adequate EF (AEF) 71.7%) before treatment. Similar SHIM results in 810 (47.4%) were 70%. At 2, 5 and last follow-up years AEF was present in 229 (22.9%), 227 (19.6%) and 227 (19.6%) of men presenting with MSSFI 2 and 309 (30.9%) 202 (26.2%) and 245 (17.3%) of the MSSFI 3s (p<0.001). SHIM data was similar (p<0.001). KM estimates for preservation of AEF in men with 2 at presentation was 75.5% at 5 and 35.5% at 10 years, while with 3 was 92.2% and 57.3% (p<0.001), respectively. 10-year AEF in the 3 age groups was 68.3%, 54.1% and 32.2% (p<0.001). AEF was further increased in these men not receiving HT to 73.4%, 62.7% and 41.6% (p<0.001). Radiation dose and T did not influence AEF. Cox HR demonstrated older age group (p<0.001, HR 2.27), addition of HT (P=0.015, HR 1.32) and low MSSIF (p<0.001, HR 1.73) as significant. CONCLUSIONS Adequate EF (MSSFI and SHIM) was preserved in a high percentage of men treated by brachytherapy with long-term follow-up. Three-quarters of patients who present with normal EF (and no HT) and were younger than 60 years at the time of treatment have adequate EF for penetration 10 years later. 41.6% of those initially treated with AEF at age 70 years are estimated (KM) to have AEF in their eighties (no HT). © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1015 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Richard Stock More articles by this author Nelson Stone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...