Comparison of satisfaction with penile prosthesis implantation in patients with prostate cancer radiation therapy versus radical prostatectomy

Abstract

Background: Penile prosthesis surgery (PPS) is a commonly used treatment for erectile dysfunction (ED), either as first-line therapy or in cases refractory to other treatment options. In patients with a urologic malignancy such as prostate cancer, surgical interventions like radical prostatectomy (RP) as well as nonsurgical treatments such as radiation therapy can all induce ED. PPS as a treatment for ED has high satisfaction rates in the general population. Our aim was to compare sexual satisfaction in patients with prosthesis implantation for ED following RP versus ED following radiation therapy for prostate cancer.Methods: A retrospective chart review from our institutional database was conducted to identify patients who underwent PPS at our institution from 2011 to 2021. Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire data at least 6 months from implant operative date available was required for inclusion. Eligible patients were placed in one of two groups depending on etiology of ED-following RP or prostate cancer radiation therapy. To prevent crossover confounding; patients with history of pelvic radiation were excluded from the RP group and patients with history of RP were excluded from the radiation group. Data was obtained from 51 patients in the RP group and 32 patients in the radiation therapy group.Mean EDITS scores and additional survey questions were compared between the radiation and RP groups.Results: There was a significant difference in mean survey responses for 8 of the 11 questions in the EDITS questionnaire between the RP group and the radiation group. Additional survey questions administered also found RP patients reported significantly higher rate of satisfaction with size of penis postoperatively versus the radiation group.Conclusions: These preliminary findings, while requiring large-scale follow-up, suggest that there is greater sexual satisfaction and penile prosthesis device satisfaction in patients undergoing IPP placement following RP versus radiation therapy for prostate cancer. Use of validated questionnaires should continue to be utilized in quantifying device and sexual satisfaction following PPS.

Prostate cancer treatment modality among factors influencing penile prosthesis satisfaction

“…However, little is known about how the choice of primary treatment (surgery vs. radiation) for prostate cancer impacts eventual satisfaction in men undergoing PPS. The present study found lower satisfaction following radiation relative to surgery ( 2 ).…”

“…The authors should be applauded for this important contribution to the literature. However, there are some important factors to consider when interpreting the study findings ( 2 ). First, the radiation cohort included 32 patients in the radiation group, with only 6 of these receiving brachytherapy (BT) and the remainder receiving external beam radiation therapy (EBRT).…”

Penile prosthesis implantation after radiation therapy for prostate cancer

“…In this article, the authors performed a comparative analysis of PP satisfaction between patients who underwent RP vs. RT for PCa using standardized questionnaires ( 5 ). They concluded that patients undergoing RP had geater sexual satisfaction and device satisfaction when compared to patients undergoing RT treatment.…”