Advertisement

Effect of aging and long-term erectile function after iodine-125 prostate brachytherapy

  • Mira Keyes
    Correspondence
    Corresponding author. British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 4E6. Tel.: +1-604-877-6000; fax: +1-604-877-0505.
    Affiliations
    Vancouver Cancer Center, The British Columbia Provincial Prostate Brachytherapy Program, University of British Columbia, British Columbia Cancer Agency, Canada
    Search for articles by this author
  • Tom Pickles
    Affiliations
    Vancouver Cancer Center, The British Columbia Provincial Prostate Brachytherapy Program, University of British Columbia, British Columbia Cancer Agency, Canada
    Search for articles by this author
  • Juanita Crook
    Affiliations
    Cancer Centre for Southern Interior, The British Columbia Provincial Prostate Brachytherapy Program, University of British Columbia, British Columbia Cancer Agency, Canada
    Search for articles by this author
  • Michael McKenzie
    Affiliations
    Vancouver Cancer Center, The British Columbia Provincial Prostate Brachytherapy Program, University of British Columbia, British Columbia Cancer Agency, Canada
    Search for articles by this author
  • Arthur Cheung
    Affiliations
    Fraser Valley Cancer Centre, The British Columbia Provincial Prostate Brachytherapy Program, University of British Columbia, British Columbia Cancer Agency, Canada
    Search for articles by this author
  • Ingrid Spadinger
    Affiliations
    Vancouver Cancer Center, The British Columbia Provincial Prostate Brachytherapy Program, University of British Columbia, British Columbia Cancer Agency, Canada
    Search for articles by this author
  • Vincent LaPointe
    Affiliations
    Vancouver Cancer Center, The British Columbia Provincial Prostate Brachytherapy Program, University of British Columbia, British Columbia Cancer Agency, Canada
    Search for articles by this author
  • W. Francois Bachand
    Affiliations
    Cancer Centre for Southern Interior, The British Columbia Provincial Prostate Brachytherapy Program, University of British Columbia, British Columbia Cancer Agency, Canada
    Search for articles by this author
  • James Morris
    Affiliations
    Vancouver Cancer Center, The British Columbia Provincial Prostate Brachytherapy Program, University of British Columbia, British Columbia Cancer Agency, Canada
    Search for articles by this author
Published:February 13, 2015DOI:https://doi.org/10.1016/j.brachy.2015.01.001

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Brachytherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Peltier A.
        • van Velthoven R.
        • Roumeguere T.
        Current management of erectile dysfunction after cancer treatment.
        Curr Opin Oncol. 2009; 21: 303-309
        • Morris W.J.
        • Keyes M.
        • Spadinger I.
        • et al.
        Population-based 10-year oncologic outcomes after low-dose-rate brachytherapy for low-risk and intermediate-risk prostate cancer.
        Cancer. 2013; 119: 1537-1546
        • Grimm P.D.
        • Billiet I.
        • Bostwick D.G.
        • et al.
        Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group.
        BJU Int. 2012; 109: 22-29
        • Alemozaffar M.
        • Regan M.M.
        • Cooperberg M.R.
        • et al.
        Prediction of erectile function following treatment for prostate cancer.
        JAMA. 2011; 306: 1205-1214
        • Barry M.J.
        • Gallagher P.M.
        • Skinner J.S.
        • et al.
        Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of medicare-age men.
        J Clin Oncol. 2012; 30: 513-518
        • Rosen R.C.
        • Fisher W.A.
        • Eardley I.
        • et al.
        The multinational Men's Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population.
        Curr Med Res Opin. 2004; 20: 607-617
        • Johannes C.B.
        • Araujo A.B.
        • Feldman H.A.
        • et al.
        Incidence of erectile dysfunction in men 40 to 69 years old: Longitudinal results from the Massachusetts male aging study.
        J Urol. 2000; 163: 460-463
        • Keyes M.
        • Morris W.J.
        • Spadinger I.
        • et al.
        Radiation oncology and medical physicists quality assurance in British Columbia Cancer Agency Provincial Prostate Brachytherapy Program.
        Brachytherapy. 2013; 12: 343-355
        • Keyes M.
        • Spadinger I.
        • Liu M.
        • et al.
        Rectal toxicity and rectal dosimetry in low-dose-rate iodine-125 permanent prostate implants: A long-term study in 1006 patients.
        Brachytherapy. 2012; 11: 199-208
        • Keyes M.
        • Miller S.
        • Moravan V.
        • et al.
        Predictive factors for acute and late urinary toxicity after permanent prostate brachytherapy: Long-term outcome in 712 consecutive patients.
        Int J Radiat Oncol Biol Phys. 2009; 73: 1023-1032
        • Sylvester J.E.
        • Grimm P.D.
        • Eulau S.M.
        • et al.
        Permanent prostate brachytherapy preplanned technique: The modern Seattle method step-by-step and dosimetric outcomes.
        Brachytherapy. 2009; 8: 197-206
        • Kupelian V.
        • Shabsigh R.
        • Travison T.G.
        • et al.
        Is there a relationship between sex hormones and erectile dysfunction? Results from the Massachusetts Male Aging Study.
        J Urol. 2006; 176: 2584-2588
        • Gomez-Iturriaga Pina A.
        • Crook J.
        • Borg J.
        • et al.
        Median 5 year follow-up of 125iodine brachytherapy as monotherapy in men aged < or =55 years with favorable prostate cancer.
        Urology. 2010; 75: 1412-1416
        • Snyder K.M.
        • Stock R.G.
        • Buckstein M.
        • et al.
        Long-term potency preservation following brachytherapy for prostate cancer.
        BJU Int. 2012; 110: 221-225
        • Crook J.M.
        • Gomez-Iturriaga A.
        • Wallace K.
        • et al.
        Comparison of health-related quality of life 5 years after SPIRIT: Surgical Prostatectomy Versus Interstitial Radiation Intervention Trial.
        J Clin Oncol. 2011; 29: 362-368
        • Taira A.V.
        • Merrick G.S.
        • Galbreath R.W.
        • et al.
        Erectile function durability following permanent prostate brachytherapy.
        Int J Radiat Oncol Biol Phys. 2009; 75: 639-648
        • Whaley J.T.
        • Levy L.B.
        • Swanson D.A.
        • et al.
        Sexual function and the use of medical devices or drugs to optimize potency after prostate brachytherapy.
        Int J Radiat Oncol Biol Phys. 2012; 82: e765-e771
        • Van der Wielen G.J.
        • Mulhall J.P.
        • Incrocci L.
        Erectile dysfunction after radiotherapy for prostate cancer and radiation dose to the penile structures: A critical review.
        Radiother Oncol. 2007; 84: 107-113
        • Stember D.S.
        • Mulhall J.P.
        The concept of erectile function preservation (penile rehabilitation) in the patient after brachytherapy for prostate cancer.
        Brachytherapy. 2012; 11: 87-96
        • Macdonald A.G.
        • Keyes M.
        • Kruk A.
        • et al.
        Predictive factors for erectile dysfunction in men with prostate cancer after brachytherapy: Is dose to the penile bulb important?.
        Int J Radiat Oncol Biol Phys. 2005; 63: 155-163
        • Mazzola C.
        • Mulhall J.P.
        Penile rehabilitation after prostate cancer treatment: Outcomes and practical algorithm.
        Urol Clin North Am. 2011; 38: 105-118
        • Pahlajani G.
        • Raina R.
        • Jones J.S.
        • et al.
        Early intervention with phosphodiesterase-5 inhibitors after prostate brachytherapy improves subsequent erectile function.
        BJU Int. 2010; 106: 1524-1527
        • Matsushima M.
        • Kikuchi E.
        • Maeda T.
        • et al.
        A prospective longitudinal survey of erectile dysfunction in patients with localized prostate cancer treated with permanent prostate brachytherapy.
        J Urol. 2013; 189: 1014-1018
        • Candy B.
        • Jones L.
        • Williams R.
        • et al.
        Phosphodiesterase type 5 inhibitors in the management of erectile dysfunction secondary to treatments for prostate cancer: Findings from a Cochrane systematic review.
        BJU Int. 2008; 102: 426-431
        • Zelefsky M.J.
        • Shasha D.
        • Branco R.D.
        • et al.
        Prophylactic sildenafil citrate improves selected aspects of sexual function in men treated by radiotherapy for prostate cancer.
        J Urol. 2014; 192: 868-874
        • Pisansky T.M.
        • Pugh S.L.
        • Greenberg R.E.
        • et al.
        Tadalafil for prevention of erectile dysfunction after radiotherapy for prostate cancer: The Radiation Therapy Oncology Group [0831] randomized clinical trial.
        JAMA. 2014; 311: 1300-1307