Relationship between radiation doses and erectile function deterioration in patients with localized prostate cancer treated with permanent prostate brachytherapy.

Abstract

To investigate the relationship between radiation doses in prostate brachytherapy and deterioration of erectile function in patients with localized prostate cancer. A longitudinal survey study was carried out among 261 prostate cancer patients who received prostate brachytherapy. A total of 48 patients were potent at baseline and they did not receive any supplemental therapy preoperatively. Dosimetry parameters of the whole prostate gland, prostate apex, urethra and rectum were collected using the VariSeed 8.0 treatment planning system (Varian Medical Systems, Palo Alto, CA, USA). We carried out a logistic regression analysis to clarify the relationship between radiation doses and erectile function deterioration, which was assessed using the International Index of Erectile Function-15 questionnaire. The median patient age was 66years (range 53-70years) with a median follow-up time of 44months (36-71months). The mean total International Index of Erectile Function-15 score decreased from 49.9 at baseline to 34.7 after 12months (P<0.001), but gradually plateaued within 36months. Erectile function deterioration was noted in 32 (66.7%) patients 36months after prostate brachytherapy. In an analysis of risk factors for erectile function deterioration after prostate brachytherapy, age ≥70years (P=0.029), prostate V100 ≥95% (P=0.024), apex V100 ≥95% (P=0.024), apex V150 ≥70% (P=0.009) and apex D90 ≥150Gy (P=0.011) correlated with erectile function deterioration. A multivariate analysis identified an age of ≥70years (odds ratio 7.91, P=0.024) and apex V150 ≥70% (odds ratio 7.75, P=0.007) as independent risk factors for erectile function deterioration after prostate brachytherapy. An excessive radiation dose, particularly to the prostate apex area, and an advanced age might have a negative impact on the preservation of potency after prostate brachytherapy.