Patient‐reported sexual quality of life after different types of radical prostatectomy and radiotherapy: Analysis of a population‐based prospective cohort

Abstract

BACKGROUND: Although patients with prostate cancer face many treatment options, to the authors' knowledge the comparative effects of different surgical and radiotherapy (RT) options on sexual function are unclear. METHODS: In the current study, a population-based cohort of 835 men with newly diagnosed prostate cancer from 2011 through 2013 was recruited throughout North Carolina in collaboration with the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry. All men were enrolled prior to treatment and followed prospectively using the validated Prostate Cancer Symptom Indices (PCSI) instrument. This analysis compares the sexual dysfunction scores of the PCSI among patients who received external-beam RT (EBRT), EBRT with androgen deprivation therapy (ADT), brachytherapy, nerve-sparing radical prostatectomy (RP), and non-nerve-sparing RP. Propensity scores were used to balance patient characteristics across groups, and multiple imputation was used for missing data. RESULTS: EBRT and brachytherapy resulted in similar PCSI scores through 24 months. Compared with those receiving EBRT, patients treated with EBRT with ADT and RP with or without nerve sparing were found to have worse PCSI scores at all posttreatment time points. Preservation of useful sexual function at 24 months was associated with treatment type, baseline score, and age. Predicted preservation rates were 14.1% to 70.7% for EBRT, 8.4% to 52.3% for EBRT with ADT, 4.7% to 45.3% for nerve-sparing RP, and 4.8% to 34.5% for non-nerve-sparing RP. CONCLUSIONS: The findings of the current study indicate that RT alone results in the best preservation of sexual function, and brachytherapy provides similar outcomes. RT with ADT and nerve-sparing RP yielded similar outcomes, whereas patients treated with non-nerve-sparing RP experienced the worst sexual function. These results help patients to make decisions among the specific types of surgery and RT they face based on each individual's diagnosis. Cancer 2019;125:3657-3665.

Effect of Brachytherapy vs. External Beam Radiotherapy on Sexual Function in Patients With Clinically Localized Prostate Cancer: A Meta-Analysis

“…The combined interval fell to the left of the invalid line ( p = 0.008), demonstrating that the sexual function of localized PCa was less affected by BT than EBRT by the EPIC scale. In the three articles using the PCSI scale ( Chen et al, 2017 ; Jia and Zhang, 2018 ; Mullins et al, 2019 ), no heterogeneity was observed (I 2 = 0%), using the fixed-effects model. The test for overall effect showed that Z = 0.05, SMD = 0.00, 95% CI: −0.14 to 0.15, the merged interval crossed the invalid line, and there was no significant difference ( p = 0.96).…”

“…In addition, the follow-up plan was defined appropriately before the evaluation of the sexual function and implemented as scheduled. Three studies ( Ferrer et al, 2008 ; Chen et al, 2017 ; Mullins et al, 2019 ) independently evaluated the results using a blind method; four clinical trials ( Ferrer et al, 2008 ; Guedea et al, 2009 ; van Tol-Geerdink et al, 2013 ; Chen et al, 2017 ) specified the missing rate at the beginning or described the lost visits after the trial; and five studies ( Ferrer et al, 2008 ; Pardo et al, 2010 ; Ferrer et al, 2013 ; Jia and Zhang, 2018 ; Mullins et al, 2019 ) performed stratified or covariate analysis to control for confounding bias, as shown in Figures 2A,B , where “green” represents low risk, “yellow” represents unknown risk, and “red” represents high risk.…”

“…Among the eight studies, five ( Ferrer et al, 2008 ; Guedea et al, 2009 ; Pardo et al, 2010 ; Ferrer et al, 2013 ; van Tol-Geerdink et al, 2013 ) used the EPIC scale, and three ( Chen et al, 2017 ; Jia and Zhang, 2018 ; Mullins et al, 2019 ) used the PCSI scale. Knowing that a higher score in the EPIC scale suggests a better sexual function, the mean PCSI score was dealt with a minus in the forest plot to align the direction of all scales as shown in Figure 3 .…”

Racial and Ethnic Disparities in Health Status, Chronic Conditions, and Behavioral Risk Factors Among Prostate Cancer Survivors, United States, 2015

“…Many studies of prostate cancer survivors have reported on the outcomes associated with sexual function, urinary or bowel incontinence, or the emotional side effects after treatment ( 29 , 30 ). Our study contributes to a gap in research on the physical health and behavioral risk factors of prostate cancer survivors.…”

Erectile dysfunction and cancer: current perspective

“…Incidence of post-treatment ED in prostate cancer can vary from 24% (brachytherapy alone), 40% (brachytherapy plus external beam radiotherapy [EBRT]), 45% (EBRT alone), 66% (nerve-sparing radical prostatectomy [RP]), 75% (non-nerve sparing RP), and 87% for cryosurgery [ 1 ]. Recently in a population based study patient reported sexual outcome after different types of prostate cancer treatment were reported [ 2 ]. Sexual dysfunction after treatment was related to pre-treatment potency, age and type of treatment.…”