Radiation Oncology/Toxicity/Erectile dysfunction

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Erectile Dysfunction


Contents

[edit] Assessment tools

  • International Index of Erectile Function (IIEF) - Sexual health inventory for men
    • Original 15-item questionnaire (IIEF-15):
      • PMID 9187685, 1997 — "The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction." Rosen RC et al. Urology. 1997 Jun;49(6):822-30.
    • 5-item questionnaire (IIEF-5):
      • Score range 5-25. Severe 5-7, moderate 8-11, mild to moderate 12-16, mild 17-21, no ED 22-25.
      • PMID 10637462, 1999 — "Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction." Rosen RC et al. Int J Impot Res. 1999 Dec;11(6):319-26.
      • PMID 12152112, 2002 — "The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction." Rhoden EL et al. Int J Impot Res. 2002 Aug;14(4):245-50.
      • Form: PDF from www.njurology.com and Online version - at medal.org


[edit] Brachytherapy

  • University of Washington; 2009 (2001-2003) PMID 19303721 -- "Erectile function durability following permanent prostate brachytherapy." (Taira AV, Int J Radiat Oncol Biol Phys. 2009 Nov 1;75(3):639-48. Epub 2009 Mar 21.)
    • Retrospective. 226 patients, treated with brachytherapy in 2 prospective randomized trials. Potency defined using IIEF-6 score. Median F/U 6.4 years
    • Outcome: 7-year potency rate 56%. By baseline potency score (2004 vs. 2008): 29-30: 75% vs 74%, 24-28: 52% vs. 45%, 18-23: 48% vs. 40%, 13-17: 23% vs. 23%. Multivariate predictors were preimplant IIEF score, HTN, DM, prostate size, dose to proximal penis
    • Dosimetry: Penile bulb D25 <50% 71% vs. >50% 45% (SS); highest impact in mild baseline dysfunction (IIEF score 18-23), where D25 <50% potency 73% vs. >50% 14% (SS)
    • Conclusion: Potency preservation is durable following brachytherapy; penile bulb sparing may further improve it

[edit] Penile Bulb Dose

  • RTOG 9406; 2004 PMID 15590164 -- "Penile bulb dose and impotence after three-dimensional conformal radiotherapy for prostate cancer on RTOG 9406: findings from a prospective, multi-institutional, phase I/II dose-escalation study." (Roach M, Int J Radiat Oncol Biol Phys. 2004 Dec 1;60(5):1351-6.)
    • Subset analysis, 158 men potent at entry
    • Outcome: "Remained potent" if median dose <52.5 Gy 68% vs. >52.5 Gy 52%; "Became impotent" 32% vs. 48%. Median dose to penile bulb if "remained potent" 49.8 Gy vs. "became impotent" 60.3 Gy. In MVA, age, dose to prostate, ADT correlated with risk of impotence
    • Conclusion: Dose to penile bulb associated with risk of radiation-induced impotence


[edit] Meta-Analysis

  • Robinson; 2002 PMID 12419432 -- "Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma." (Robinson JW, Int J Radiat Oncol Biol Phys. 2002 Nov 15;54(4):1063-8.)
    • Meta-analysis. 54 studies including brachytherapy, brachytherapy + EBRT, EBRT alone, standard RP and nerve-sparing RP, cryotherapy


Proportion with Erectile Dysfunction
Therapy 1-year 2+ years Age-adjusted
Brachytherapy 24% N/A 20%
Brachytherapy + EBRT 40% 40% 31%
EBRT alone 45% 48% 32%
Radical Prostatectomy, Standard 75% 75% 84%
Radical Prostatectomy, Nerve-sparing 66% 75% 78%
Cryotherapy 87% 85% 87%
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