Abstract
Purpose
To evaluate long-term erectile function (EF) in men treated with iodine-125 prostate
brachytherapy (PB) and to determine factors predictive for erectile dysfunction (ED),
including natural decline because of aging.
Methods
Two thousand nine hundred twenty-nine patients (implanted July 1989–June 2012) with
baseline EF and greater than 10-month followup (FU) are included. About 78.9% had
full and 7.9% had partial EF at baseline. EF was assessed on a physician-reported
three-point scale. Poisson regression with generalized estimating equations was used
to assess predictors of ED and Kaplan–Meier curves time to ED. The effect of aging
was calculated from the declining rate of baseline EF seen in sequential 5-year age
cohorts and from the Massachusetts Male Aging Study.
Results
The median age was 66 years and median FU 3.5 years (maximum 14 years). About 1142
patients had more than 5 years of FU, and 43% had received 6 months of androgen deprivation
therapy (ADT). Significant drop in EF was seen at 6 weeks after PB, with gradual decline
thereafter. EF preservation at 5 years for age younger than 55, 56–59, 60–64, 65–69,
and 70 year and older was 82%, 73%, 58%, 39%, and 23%, respectively. Comparisons of
the 5-year age-related and treatment-related EF decline show that 50% of the long-term
EF decline is related to aging. On univariate and multivariate analyses, age at implant,
length of FU, hypertension, diabetes, and use of ADT (all p < 0.01) were significant predictors of ED.
Conclusion
More than 80% of young men have EF preserved 5 years after PB. Age, ADT, history of
hypertension, and the natural decline in EF have negative impact on long-term EF after
PB.
Keywords
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Article info
Publication history
Published online: February 13, 2015
Accepted:
January 6,
2015
Received in revised form:
January 4,
2015
Received:
November 12,
2014
Identification
Copyright
© 2015 Published by Elsevier Inc. All rights reserved.
