Prostatic irradiation-induced sexual dysfunction: A review and multidisciplinary guide to management in the radical radiotherapy era (Part II on Urological Management)

Rogers, Marc J.; Ramírez-Fort, Marigdalia K.; Kashanian, James A.; Broster, Seth A.; Matta, Jaime; Mahase, Sean S.; Fort, Digna V.; Niaz, Muhammad Junaid; McClelland, Shearwood; Bander, Neil H.; Fort, Migdalia; Lange, Christopher S.; Mulhall, John P.

doi:10.1016/j.rpor.2020.03.011

Cited by 8 publications

(5 citation statements)

References 57 publications

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“…Beginning from a possible mechanismlevel etiology, ED following post-RP is generally more well understood versus radiation induced ED (7,14,15). Studies on radiation induced ED are ongoing, and there are few published studies regarding this topic as it continues to be less definitively understood than following surgical management of prostate cancer (16,17). Secondly, patient characteristics may differ in the two cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study looked at possible determinants of patient satisfaction following PPS and did find reduced satisfaction in those with a history of RP, however, this was by comparing pre-and post-operative satisfaction rates as quantified by various scales (33). Research on optimizing treatment of sexual dysfunction in patients undergoing prostatic irradiation, which includes treatment via PPS, is ongoing and provides an opportunity to consequently improve patient satisfaction as well (17).…”

Section: Discussionmentioning

confidence: 99%

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

Mehr¹,

Blum²,

Green³

et al. 2023

Transl Androl Urol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Mehr¹,

Blum²,

Green³

et al. 2023

Transl Androl Urol

View full text Add to dashboard Cite

show abstract

“…Of significance, there was improvement in sexual function between 6 months and 2 years post-prostatectomy while there was a slight decline in function over time in patients receiving radiation. Another study showed that the rate of ED after RT increased over time from 4% to 47% in 5 years, secondary to irreversible, slowly progressing vascular damage [ 26 ]. These finding are in line with our study results showing a much longer time span from treatment of prostate cancer to ED diagnosis for patients with radiation compared to patients with prostatectomy (median 346 vs. 133 days).…”

Section: Discussionmentioning

confidence: 99%

Relationships between erectile dysfunction, prostate cancer treatment type and inflatable penile prosthesis implantation

et al. 2022

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Purpose The prevalence of erectile dysfunction (ED) and the utilization of inflatable penile prosthesis (IPP) among prostate cancer patients are understudied. The aim of the study was to examine the relationships between ED, prostate cancer treatment type and IPP implantation in a national cohort. Materials and Methods We identified a retrospective cohort of Surveillance, Epidemiology, and End Results (SEER)-Medicare patients diagnosed with locoregional prostate cancer between 2006 and 2011 and treated with surgery or radiation. Chi-square tests were used to detect significant differences in ED rates as well as use of IPP among the subset with ED. Multivariable logistic regression was used to examine factors associated with the use of IPP. Results Among 31,233 patients in our cohort, 10,334 (33.1%) received prostatectomy and 20,899 (66.9%) received radiation. ED within 5 years was significantly more common in the prostatectomy group relative to those the radiation group (65.3% vs. 33.8%, p<0.001). In the subset of 13,812 patients with ED, the radiation group had greater median time to ED diagnosis compared to the prostatectomy group (346 vs. 133 days, p<0.001). IPP implantation was more frequent for prostatectomy patients than for radiation patients (3.6% vs. 1.4%, p<0.001). Cancer treatment type, race, and marital status were significantly associated with IPP utilization. Conclusions ED is highly prevalent among prostate cancer patients, and IPP implantation is be underutilized. ED rates, time to ED diagnosis and utilization of IPP differed significantly by prostate cancer treatment type.

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“…A recent review by Ramirez-Fort et al highlights the role of the ejaculatory ducts and the neurovascular plexus; the latter is adherent to the posterior part of the prostate gland and is therefore difficult to avoid with current imageguided radiotherapy modalities. Assuming an anatomic similarity to the brachial plexus, the authors hypothesize a similar dose constraint in conventional fractionation with a Dmax<75 Gy to 2 cc ( [64,65,69]-Figure 4).…”

Section: Sexual Function Preservationmentioning

confidence: 99%

MR-Guided Hypofractionated Radiotherapy: Current Emerging Data and Promising Perspectives for Localized Prostate Cancer

Cuccia

Corradini

Mazzola

et al. 2021

Cancers

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In this review we summarize the currently available evidence about the role of hybrid machines for MR-guided radiotherapy for prostate stereotactic body radiotherapy. Given the novelty of this technology, to date few data are accessible, but they all report very promising results in terms of tolerability and preliminary clinical outcomes. Most of the studies highlight the favorable impact of on-board magnetic resonance imaging as a means to improve target and organs at risk identification with a consequent advantage in terms of dosimetric results, which is expected to relate to a more favorable toxicity pattern. Still, the longer treatment time per session may potentially affect the patient’s compliance to the treatment, although first quality of life assessment studies have reported substantial tolerability and no major impact on quality of life. Finally, in this review we hypothesize some future scenarios of further investigation, based on the possibility to explore the superior anatomy visualization and the role of daily adapted treatments provided by hybrid MR-Linacs.

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Prostatic irradiation-induced sexual dysfunction: A review and multidisciplinary guide to management in the radical radiotherapy era (Part II on Urological Management)

Cited by 8 publications

References 57 publications

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

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

Relationships between erectile dysfunction, prostate cancer treatment type and inflatable penile prosthesis implantation

MR-Guided Hypofractionated Radiotherapy: Current Emerging Data and Promising Perspectives for Localized Prostate Cancer

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