Prostate

Patient-reported sexual quality of life after different types of radical prostatectomy and radiotherapy: Analysis of a population-based prospective cohort - PDF version
Mullins BT, Basak R, Broughman JR, Chen RC.
Cancer.   2019 Oct 15;125(20):3657-3665 PMID:31256432

BACKGROUND:
Although patients with prostate cancer face many treatment options, to the authors' knowledge the comparative effects of different surgical and radiotherapy 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 to 2013 was recruited throughout North Carolina, USA, 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 radiotherapy (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 over 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 post-treatment 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 radiotherapy alone results in the best preservation of sexual function, and brachytherapy provides similar outcomes. Radiotherapy 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 radiotherapy they face based on each individual's diagnosis.