Erectile Function Outcome Reporting After Clinically Localized Prostate Cancer Treatment

Burnett, Arthur L.; Aus, Gunnar; Canby-Hagino, Edith; Cookson, Michael S.; D’Amico, Anthony V.; Dmochowski, Roger R.; Eton, David T.; Forman, Jeffrey D.; Goldenberg, S. Larry; Hernández, Javier; Higano, Celestia S.; Kraus, Stephen R.; Liebert, Monica; Moul, Judd W.; Tangen, Catherine M.; Thrasher, J. Brantley; Thompson, Ian M.

doi:10.1016/j.juro.2007.03.140

Cited by 188 publications

(123 citation statements)

References 20 publications

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“…17 Various studies have reported erectile function outcomes after radical prostatectomy, 18 brachytherapy, 19 or external-beam radiotherapy with or without brachytherapy 20,21 using the IIEF-5. Many more studies have used the EPIC to assess ED in prostate cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Defining potency: A comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite

Schroeck

Donatucci

Smathers

et al. 2008

Cancer

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BACKGROUND.Both the 5‐item short version of the International Index of Erectile Function (IIEF‐5) and the Expanded Prostate Cancer Index Composite (EPIC) have been used to assess erectile function. In this study, the authors compared various definitions of potency according to the IIEF‐5 and the EPIC.METHODS.Patients with prostate cancer who had completed the IIEF‐5 and the EPIC within 7 days of each other were included. The Spearman correlation coefficient (rho) was calculated to assess the relation between IIEF‐5 and EPIC sexual domain scores. Concordance of potency rates by IIEF‐5 and EPIC was assessed in cross‐tabulations. By calculating the area under the receiver operator characteristics (ROC) curve (AUC), the authors ascertained the discriminative ability of the IIEF‐5 score to identify potent men as defined by the EPIC.RESULTS.Analyzing 102 questionnaire pairs, IIEF‐5 and EPIC domain scores were found to be highly correlated (rho = 0.776). EPIC sexual domain scores ≥60 had high concordance with IIEF‐5 scores ≥17 (98%) and with nearly all single‐item definitions of potency (≥71%). However, an EPIC sexual domain score ≥80 was a very strict definition of potency, and only 54% of patients with IIEF‐5 scores ≥22 met this threshold. On the basis of ROC analysis (AUC = 0.90), an IIEF‐5 score ≥20 was identified as the ideal cutoff for defining potency and corresponded with an EPIC sexual domain score ≥60.CONCLUSIONS.IIEF‐5 and EPIC scores were highly correlated, but potency rates varied widely, depending on the definition of potency. The current results help with the interpretation of sexual function outcomes data in patients with prostate cancer. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Defining potency: A comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite

Schroeck

Donatucci

Smathers

et al. 2008

Cancer

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“…2 ED is estimated to affect 26--100% of patients after surgery. 3,4 The main cause of ED after RP is neurogenic, because of intraoperative injury to the neurovascular bundle. 5 However, other mechanisms including arterial trauma and neuropraxia-associated structural alterations in corporal smooth muscle may also have a role.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 The main cause of ED after RP is neurogenic, because of intraoperative injury to the neurovascular bundle.…”

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confidence: 99%

Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial

et al. 2012

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Erectile dysfunction (ED) and urinary incontinence are common complications following radical prostatectomy (RP). Although pelvic-floor biofeedback training (PFBT) may improve urinary continence following RP, its effects on the recovery of potency are unknown. Fifty-two patients selected for RP were prospectively randomized for a treatment group (n ¼ 26) receiving PFBT once a week for 3 months and home exercises or a control group (n ¼ 26), in which patients received verbal instructions to contract the pelvic floor. Erectile function (EF) was evaluated with the International Index of Erectile Function-5 (IIEF-5) before surgery and 1, 3, 6 and 12 months postoperatively. Patients were considered potent when they had a total IIEF-5 score 420. Continence status was assessed and defined as the use of no pads. Groups were comparable in terms of age, body mass index, diabetes, pathological tumor stage and neurovascular bundle preservation. A significant reduction in IIEF-5 scores was observed after surgery in both groups. In the treatment group, 8 (47.1%) patients recovered potency 12 months postoperatively, as opposed to 2 (12.5%) in the control group (P ¼ 0.032). The absolute risk reduction was 34.6% (95% confidence interval (CI): 3.8--64%) and the number needed to treat was 3 (95% CI: 1.5--17.2). A strong association between recovery of potency and urinary continence was observed, with continent patients having a 5.4 higher chance of being potent (P ¼ 0.04). Early PFBT appears to have a significant impact on the recovery of EF after RP. Urinary continence status was a good indicator of EF recovery, with continent patients having a higher chance of being potent. 1 The most common long-term complications after prostatectomy (RP) are urinary incontinence and erectile dysfunction (ED).2 ED is estimated to affect 26--100% of patients after surgery. 3,4 The main cause of ED after RP is neurogenic, because of intraoperative injury to the neurovascular bundle.

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“…25 The magnitude of RT as a confounding factor is impossible to estimate because we did not have a control group that received RT monotherapy in our study and the post-RT rates of ED reported in the literature vary from 8 to 85%. 26 Among 875 patients in the SPCG-7 study, the proportions of men with physician-reported ED at baseline and at the 5-year follow-up were 33% and 81% in those who received AA monotherapy and 36% and 89% in those who received AA þ RT. 4 These results show that long-term AA treatment, even though applied alone, is associated with severe impairment of sexual function.…”

Section: Discussionmentioning

confidence: 99%

Definitive radiotherapy with adjuvant long-term antiandrogen treatment for locally advanced prostate cancer: health-related quality of life and hormonal changes

Berg

Dahl

Bruland

et al. 2009

Prostate Cancer Prostatic Dis

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We assessed self-reported health-related quality of life (HRQoL) and longitudinal changes in sex hormones among 86 prostate cancer (PCa) patients without distant metastases 5 years after radiotherapy (RT) combined with ongoing antiandrogen (AA) treatment. HRQoL outcomes were compared with scores from age-matched controls without a cancer diagnosis (NORM). Compared with NORM, patients scored statistically (Po0.05) and clinically (effect size X0.4) lower on sexual domains, and statistically (Po0.05) lower on physical function and vitality. Estimated free testosterone and measured serum estradiol had increased from baseline in most patients, but did not correlate with HRQoL outcomes 5 years after the start of treatment.

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Erectile Function Outcome Reporting After Clinically Localized Prostate Cancer Treatment

Cited by 188 publications

References 20 publications

Defining potency: A comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite

Defining potency: A comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite

Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial

Definitive radiotherapy with adjuvant long-term antiandrogen treatment for locally advanced prostate cancer: health-related quality of life and hormonal changes

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