Prospective four years of evaluation of erectile function after low-dose-rate prostate brachytherapy using baseline IIEF-5 > 16

Abstract

Purpose Prostate brachytherapy (BT) is a validated treatment for localized prostate cancer (CaP) and an attractive therapy option for patients seeking to preserve erectile function (EF). The aim of this paper is to prospectively assess EF evolution during 4 years after BT. Material and methods Between February 2007 and July 2012, 179 patients underwent an exclusive Iodine-125 BT, for low-intermediate favorable risk CaP of whom, 102 had an initial international index of erectile function 5 score (IIEF-5) > 16 and were included in the study. Of those, 12.7% received neo-adjuvant hormonotherapy (HT) to decrease the prostate volume. Post-BT intake of phosphodiesterase inhibitors (PDE5i) was not an exclusion criterion. Erectile function was prospectively assessed using a validated questionnaire IIEF-5 before treatment and annually for 4 years. Results At 1-year follow-up, 54% of patients preserved an IIEF-5 > 16 and only 8% suffered from severe ED. During the next 3 years, the results were not statistically different. The mean IIEF-5 lost 4 points during the first year, 17 vs. 21, and remained stable during the following 3 years. We did not find any significant differences in the proportion of patients treated by PDE5i (18-20%). As for patients with a normal preoperative IIEF-5 (> 21) ( n = 52), 35-42% preserved a normal EF and 71-77% maintained an IIEF-5 > 16, including 13-19% of patients who needed PDE5i. Those results were stable for over 4 years. Conclusions During the first 4 years after BT, more than half of patients maintained an IIEF-5 > 16, and EF results remained stable. Severe erectile dysfunction (ED) was very rare.

Focal low-dose-rate prostate brachytherapy for low- and intermediate-risk prostate cancer

“…Toxicity was evaluated at baseline and every 1-2 months post-operatively. Sexual dysfunction is often evaluated after brachytherapy [ 16 ]; however, this was impossible in this study because 15 of the 19 patients (79%) exhibited severe erectile dysfunction (ED) prior to focal brachytherapy. None requested medication; thus, we could not determine whether ED was refractory to medication.…”

Clinic Utilization and Characteristics of Patients Accessing a Prostate Cancer Supportive Care Program’s Sexual Rehabilitation Clinic

“…This can partially be attributed to the known improvement in erectile function over time following PC treatment. However, the majority of sexual recovery occurs in the first 18 months after treatment, with the most significant increase happening in the first 6 months [ 18 , 19 ]. Median IIEF-5 scores have been shown to increase 13–17 points from 6 weeks post-operatively to 18 months post-operatively for patients treated with RP [ 18 ], but, to our knowledge, no studies exist looking specifically at increase of the IIEF-5 subset score of sexual satisfaction over time in PC survivors without intervention.…”

Toxicity in patients treated with permanent prostate brachytherapy using intraoperatively built custom-linked seeds versus loose seeds

“…It is known that patients treated with 125 I low-dose-rate BT have overall very few complications [ 23 ]. During the first 4 years after BT, more than a half of patients maintain an IIEF-5 > 16, with very rare severe erectile dysfunction [ 24 ]. In a series of 2,928 patients, erectile function was even preserved in more than 80% of young patients at 5 years [ 25 ].…”