Durability of erectile function following brachytherapy

The long-term durability of erectile function after treatment for prostate cancer is dependent on a wide range of factors, including age, type of therapy, other medical conditions, etc. A recent study has assessed long-term changes in erectile function following prostate brachytherapy.

The study by Taira et al. included 226 prostate cancer patients whose erectile function was assessed using the International Index of Erectile Function-6 (IIEF-6) before and after treatment with brachytherapy in two prospective, randomized trials between February 2001 and January 2003. Pre- and post-brachytherapy potency was defined as an IIEF-6 score of 13 or higher without pharmacologic or mechanical support.

Study results can be summarized as follows:

  • Median follow-up of all patients was 6.4 years.
  • The 7-year actuarial rate of potency preservation was 55.6 percent, with a median post-treatment IIEF score of 22 in potent patients.
  • Potent patients were younger, had a higher pre-treatment IIEF score, were less likely to be diabetic, and were more likely to report nocturnal erections.
  • Potency preservation was closely correlated to baseline IIEF scores over time:
    • For men with a baseline IIEF score of 29-30, potency rates were 75.5 percent in 2004 vs. 73.6 percent in 2008.
    • For men with a baseline IIEF score of 24-28, potency rates were 51.7 percent in 2004 vs. 44.8 percent in 2008.
    • For men with a baseline IIEF score of 18-23, potency rates were 40.0 percent in 2004 vs. 40.0 percent in 2008.
    • For men with a baseline IIEF score of 13-17, potency rates were 23.5 percent in 2004 vs. 23.5 percent in 2008.
  • Hypertension, diabetes, prostate size, and brachytherapy dose to proximal penis strongly affected potency preservation.
  • The impact of proximal penile dose was most pronounced for men with a baseline IIEF score of 18-23 of between 60 and 69 years of age.
  • A significant minority of men who developed post-implant impotence ultimately regained some degree of erectile function.

The authors conclude that potency preservation and median IIEF scores following brachytherapy are durable. They note that radiation dose sparing of proximal penile structures and early penile rehabilitation may further improve these results.

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