Sexual, irritative, and voiding outcomes, following stereotactic body radiation therapy for prostate cancer

Abstract

BackgroundUrinary symptoms and sexual dysfunction are the two most common complaints following prostate radiotherapy. The impact of hypofractionated treatment on sexual function, irritative symptoms, and voiding symptoms has not been determined within the same patient population. Here we present our institutional data on sexual function, voiding function, irritative symptoms, and treatment response following SBRT.MethodsThis retrospective analysis includes 102 non-metastatic patients treated with SBRT at a single institution between May 2008 and September 2014. The course of radiotherapy consisted of 36.25 Gy (range 35–40) over five daily fractions. International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), and PSA were recorded at baseline, 1, 3, 6, 9, 12, 18, 24, and 36 months after treatment.ResultsMedian patient age was 72 years old with a median follow-up of 4.3 years. Pretreatment IPSS-I score was 5.21, increasing to 6.97 (p < .001) after 1 month. The mean IPSS-I score returned close to baseline after 3 months to 5.86 and decreased to below baseline after 2 years to 5.09. At 3 months, 9 months, and 2 years, 47.5, 76.2, and 91.1 % of patients had reached IPSS-I resolution. The mean IPSS-O score prior to treatment was 5.31 and there was an increase in the score to 6.45 (p = 0.344) at 1 month. The score remained close to baseline and decreased to 4.00 at 2 years and significantly decreased to 3.74 (p = 0.035) at 3 years. 64.4, 82.1, and 96.0 % of patients had IPSS-O resolution by 3 months, 9 months, and 2 years. The mean SHIM score prior to treatment was 13.52 and continually decreased to below baseline a year after treatment to 10.56 (p < .001). SHIM score began to improve at 18 months, but was still significantly less than baseline at 12.12 (p = .01).ConclusionsWhile an increase in AUA/IPSS score initially occurred, all patients resume normal activities immediately following treatment and the AUA/IPSS symptoms improved from baseline. Irittative symptoms take longer to resolve when compared to obstructive voiding symptoms in patients treated with SBRT. Three year PSA response, reported toxicity, erectile function preservation, and urinary function improvement, shows favorable results.

Comparison of Late Urinary Symptoms Following SBRT and SBRT with IMRT Supplementation for Prostate Cancer

“…Furthermore, LUTS in men treated with radiation therapy are significantly worse compared to those who receive prostatectomy alone [10]. Moreover, LUTS are also reported to persist for years after completion of radiation treatment [11,12]. In some cases, LUTS may recur or worsen months or years following radiation therapy.…”

Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer

“…Typically, little improvement is seen in ED percentages over time. 11 Occasionally, these numbers stabilize or return to baseline. This was demonstrated by Siglin et al, 16 who followed several domains of sexual function in men who had undergone EBRT.…”

“…The reported incidence ranges from 10% to 60%. [10][11][12] Several animal model studies have examined stereotactic body radiation therapy to the prostate, neurovascular bundles, and penile bulb. Nolan et al 13 showed that prostatic irradiation caused arterial damage (specifically, altered internal pudendal arterial tone) and decreased motor function in the pudendal nerve (from axonal degeneration and loss).…”

Radiation-induced erectile dysfunction: Recent advances and future directions

“…Combining IMRT, hypofractionation, and a simultaneous integrated boost has been shown to be a safe and effective treatment option for prostate cancer patients. Prostate cancer patients treated with Cyberknife stereotactic body RT exhibited minimal acute toxicity 31 . Prostate-specific antigen response, toxicity, preservation of erectile function, and improvement in urinary function compare favorably to data presented following radical prostatectomy, brachytherapy, or conventional external beam RT 32 …”