O-66: Neo-adjuvant and adjuvant hormone suppression therapy adversely impacts erectile function after brachytherapy

Abstract

Brachytherapy is a commonly employed treatment modality for localized prostate cancer. Among the perceived benefits of brachytherapy is the preservation of erectile function in previously potent men. What is less clear is how adjunctive therapies including hormonal suppression and external beam radiotherapy in combination with brachtherapy effect erectile function. We examined the effect of phosphodiesterase inhibitor use in a group of previously potent men who underwent brachytherapy. We searched a prospectively compiled database of 2500 men treated for clinically localized prostate cancer with brachytherapy at the Mount Sinai Medical Center since 1992. One hundred fifty-five men were included in the analysis. Inclusion criteria were a baseline sexual health inventory for men score >/= 16, at least one follow-up Shim score (mean six month intervals), and use of a phsophodiesterase inhibitor. We stratified men by treatment type: brachytherapy (brachy) only (n=77), brachytherapy with 3 months of neo-adjuvant hormonal (brachy+h) suppression (n=27) and brachytherapy, hormonal suppression (3 months neo-adjuvant and 6 months of adjuvant) and external beam radiotherapy (brachy+h+xrt, n=51). The Wilcoxian rank sum test was used to compare groups. Mean ages of men was not significantly different. Median Gleason score was six for both the brachy alone group and the brachy+h group, and it was seven for the bracy+h+xrt group. All men in the brachy alone group had Gleason scores of six and under, while 3/27 and 36/51 had Gleason scores greater than six in the brachy+h and the brachy+h+xrt groups respectively. Mean PSA scores were 5.1, 6 and 8.86 ng/dL respectively. Baseline and follow-up Shim scores are displayed in table 1.Tabled 1 Brachytherapy is associated with a decline in Shim score after the procedure regardless of whether adjunctive therapy is used or not. However, Shim scores improve more rapidly in the groups where hormone suppression therapy is either not used or used in a neo-adjuvant fashion. By 36 months after brachytherapy implant, Shim scores are not significantly different even when adjuvant hormonal therapy is used. Hormonal therapy delays the return of sexual function when used in conjunction with brachytherapy. However, at three years after treatment, Shim scores are not significantly different in men treated with hormonal suppression and phosphodiesterase inhibitors.