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

Abstract

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.

Erectile Dysfunction in Pelvic Cancer Survivors and Current Management Options

“…The deleterious effects of radiation on EF are delayed, unlike the immediate effects of surgery, and patients may experience a progressive deterioration of erectile function [ 57 , 58 ].…”

“…Thus the majority of the literature is centered on this group of patients. In males with medically refractory ED, penile prosthesis is the only surgical option [ 9 ] and is considered the most effective method with which to achieve on-demand erections, displaying high satisfaction rates and low complications [ 15 , 57 , 58 ].…”

“…Prostatectomy patients were significantly more likely to receive an IPP vs. the RT group (3.6% vs. 1.4%, p < 0.001). ED is not unusual after prostate cancer treatment and this study suggests that IPP implantation is underused [ 58 ].…”

“…Satisfaction after a penile prosthesis is very high (over 90%) compared to those receiving pharmacologic treatment, and it is associated with the improvement in EF measured with IIEF-5 [ 9 , 15 , 57 , 58 ]. Similarly high satisfaction rates are described in IPP after pelvic radiation without an increase in infections, erosion, or mechanical failures [ 57 , 85 ].…”

“…Different authors have described that penile prosthesis has the highest satisfaction and success rates in achieving and maintaining a functional erection compared to other ED treatments [ 15 , 58 ].…”