The effect on erectile function of 103palladium implantation for localized prostate cancer : Ponholzer A, Oismuller R, Somay C, Buchler F, Maier U, Hawliczek R, Rauchenwald M, Madersbacher S, Department of Urology and Andrology, Ludwig Boltzmann Institute for Urological Oncology, Vienna, Austria

Abstract

To determine in a prospective study the effect on erectile function of (103)Pd brachytherapy for localized prostate cancer, using a validated questionnaire. Between July 1999 and April 2003, 113 men with localized prostate cancer were treated by permanent implantation of (103)Pd seeds, of whom 78 with a follow-up of 30 months were included in this study. No patient received supplemental external beam radiation therapy. At baseline and 3-month intervals, erectile function (EF) was assessed by the EF domain score of the International Index of Erectile Function-15 (IIEF-15); 77% received (neo)adjuvant antiandrogen therapy for up to 3 months. At baseline, 27 (35%) patients had no erectile dysfunction (ED; EF domain score 26–30), 24 (31%) had mild/moderate ED (score 11–25) and 27 (35%) severe ED (score 6–10). The mean EF domain score decreased from 17 to 12 (P < 0.001) after 30 months. Overall, 52 men (67%, including those with severe ED at baseline) remained in the same ED category at 30 months after therapy as before, 12 (15%) deteriorated by one category, 14 (18%) by two or more, and no patient improved. Of the 27 patients fully potent (score 26–30) at baseline, 37% remained so after 30 months, 19% developed mild and the remaining 44% moderate/severe ED. In a multivariate analysis, neither age nor preoperative prostate-specific antigen level, prostate volume, D90, hormonal treatment, diabetes, smoking or hypertension were predictive of preserving potency (P > 0.05). There was a high prevalence of pre-existing ED in these men; 57% of men fully potent or with mild ED at baseline remained so 30 months after brachytherapy.