Sexual (dys)function after radiotherapy for prostate cancer: A review
Prostate cancer has become the most common nonskin malignant neoplasm in older men in Western countries. As treatment efficacy has improved, issues related to posttherapy quality of life and sexual functioning have become more important.
We discuss the various methods used to evaluate erectile and sexual dysfunction and the definition of potency. The etiologies of erectile dysfunction after external beam radiotherapy and brachytherapy for prostate cancer are also reviewed. The literature is summarized, and comparative studies of radiation and surgery are surveyed briefly.
Rates of erectile dysfunction vary from 6 to 84% after external beam radiotherapy and from 0 to 51% after brachytherapy. In most of the studies, the analysis is retrospective, the definition of erectile dysfunction is not clear, only one question about sexual functioning is asked, and nonvalidated instruments are used. The etiology of erectile dysfunction after radiation for prostate cancer is not completely understood.
Because erectile function is only one component of sexual function, it is necessary to assess sexual desire, satisfaction, frequency of intercourse, and other such factors when evaluating the effects of therapy. Patients should be offered sexual counseling and informed about the availability of effective treatments for erectile dysfunction, such as sildenafil, intracavernosal injection, and vacuum devices.
Available from: Mary Dunne
- "Published studies report a wide degree of variation in the incidence of ED post EBRT. A review by Incrocci et al.  noted published rates of ED varying from 6% to 84% post EBRT alone. A meta-analysis of 54 studies where the pre-treatment functioning of subjects was known suggests that maintenance of EF varies widely . "
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ABSTRACT: Erectile dysfunction is a common consequence of external beam radiotherapy (EBRT) for prostate cancer. The addition of neo-adjuvant androgen deprivation (NAD) has an indeterminate additive effect. We examined the long-term effect on erectile function (EF) of two durations (4 months: arm 1 and 8 months: arm 2) of NAD prior to radiation (RT) for patients with localised prostate cancer from the Irish Clinical Oncology Research Group (ICORG 97-01) 4- versus 8-month trial. In this study we aimed to (1) analyse the overall effect on EF of NAD in an EBRT population, (2) compare the probability of retained EF over time in an EBRT population treated with either 4 or 8 months of NAD and (3) identify any variables such as risk group and age which may have an additive detrimental effect. This analysis provides unique long term follow up data.
From 1997 to 2001, 276 patients with adenocarcinoma of the prostate were randomised to 4 or 8 months of NAD before RT. EF data were recorded at baseline and at each follow-up visit by physician directed questions, using a 4-point grading system.
Two hundred and thirty patients were included in the analysis of EF and were followed for a median of 80 months. One hundred and forty-one patients had EF at baseline. Neo-adjuvant androgen deprivation in addition to radiation therapy caused a significant reduction in EF. The most significant reduction in EF happens within the first year. The median time to grade 3-4 EF toxicity was 14.6 months, 17.6 months in arm 1 and 13.7 in arm 2. Freedom from late EF toxicity did not differ significantly between arms, overall or at 5 years (n=141). The cumulative probability of EF preservation at 5 years was 28% (22-34) in arm 1 and 24% (19-30) in arm 2. Age was a significant predictor of post-treatment EF.
The first year post ADT and EBRT poses the greatest risk to sexual function and a continued decline may be expected. However, 26% of men can expect to retain sexual function at 5 years.
Available from: Tiziana Rancati
- "Erectile dysfunction (ED) is known to be an adverse side-effect after radiotherapy for prostate cancer [1-14]. The growing fraction of young patients interested in conserving their potency is leading clinicians and researchers to devote more attention to this issue, as preservation of erectile functionality can have a significant impact on the quality of life of quite a large number of patients likely to be long survivors after curative radiotherapy for prostate cancer. "
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ABSTRACT: Several investigations have recently suggested the existence of a correlation between the dose received by the penile bulb (PB) and the risk of erectile dysfunction (ED) after radical radiotherapy for clinically localized prostate carcinoma.
A prospective multi-Institute study (DUE-01) was implemented with the aim to assess the predictive parameters of ED. Previously, an evaluation of inter-observer variations of PB contouring was mandatory in order to quantify its impact on PB dose-volume parameters by means of a dummy run exercise.
Fifteen observers, from different Institutes, drew the PB on the planning CT images of ten patients; inter-observer variations were analysed in terms of PB volume variation and cranial/caudal limits. 3DCRT treatment plans were simulated to evaluate the impact of PB contouring inter-variability on dose-volume statistics parameters. For DVH analysis the values of PB mean dose and the volume of PB receiving more than 50 Gy and 70 Gy (V50 and V70, respectively) were considered. Systematic differences from the average values were assessed by the Wilcoxon test.
Seven observers systematically overestimated or underestimated the PB volume with deviations from the average volumes ranging between -48% and +34% (p < 0.05). The analysis of the cranial and caudal borders showed a prevalence of random over systematic deviations.
Inter-observer contouring variability strongly impacts on DVH parameters, although standard deviations of inter-patient differences were larger than inter-observer variations: 14.5 Gy versus 6.8 Gy for mean PB dose, 23.0% versus 11.0% and 16.8% versus 9.3% for V50 and V70 respectively.
In conclusion, despite the large inter-observer variation in contouring PB, a large multi-centric study may have the possibility to detect a possible correlation between PB % dose-volume parameters and ED. The impact of contouring uncertainty could be reduced by "a posteriori" contouring from a single observer or by introducing Magnetic Resonance Imaging (MRI) in the planning procedures and/or in improving the skill of observers through post-dummy run tutoring of those observers showing large systematic deviations from the mean.
Available from: Leli W Pedro
- "A reported 25%–65% of patients who have been treated for prostate cancer complain of diarrhea, bowel urgency, and rectal bleeding. in addition, complaints of urinary complications and sexual dysfunction also exist (Bacon et al., 2001; Eller et al., 2006; galbraith, ramirez, & Pedro, 2001; incrocci, slob, & levandag, 2002). Patients who have had surgery for prostate cancer report fewer bowel-related complications but tend to experience more urinary complications. "
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ABSTRACT: Purpose/Objectives: To describe health-related outcomes for couples dealing with prostate cancer before the patient started treatment and 6, 12, and 18 months after treatment.
Design: Survey with longitudinal, comparative, and predictive elements.
Setting: Tertiary care nonprofit medical center in the southwestern United States.
Sample: A convenience sample of 216 patients treated for prostate cancer and their partners was enrolled. The mean age of patients was 68 years; 64 years for their partners. The average length of marriage was about 35 years. About 75% of patients and more than 50% of partners had at least some college education.
Methods: Study participants completed questionnaires before treatment and 6, 12, and 18 months after treatment.
Main Research Variables: Health-related quality of life, health status, and marital satisfaction.
Findings: Patients' scores were associated with partners' scores more than 50% of the time throughout the study. Relationship satisfaction was the most strongly related variable between patient and partner. Cross-lag analyses suggest that couples' scores demonstrate a reciprocal pattern of influence between the dyads throughout the study.
Conclusions: Patients' scores were associated with partners' scores on most outcome variables. Both are affected by prostate cancer and the treatment experience.
Implications for Nursing: Nurses should actively include partners in all information and education sessions connected with prostate cancer treatment and follow-up. In addition, the unique experiences of partners of patients with prostate cancer should be identified and addressed.
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