Brachytherapy preserved erectile function in half of patients with prostate cancer

Permanent brachytherapy appears to maintain erectile function in 50% of patients with localized prostate cancer at 2 and 5 years after treatment, according to findings presented at the Congress of the European Society of Radiotherapy and Oncology.

In the prospective study, researchers assessed 285 patients, with a median age of 67.4 years, who underwent permanent prostate interstitial brachytherapy between July 1999 and October 2013. All eligible patients were required to have a minimum follow-up of 2 years and not be on an androgen deprivation therapy regimen. The median age of the study participants was 67.4 years.

Fifty-seven patients were assigned to undergo monotherapy with Pd-103 while 228 began a regimen of I-125. Nine of the I-125 patients also received external beam radiotherapy. ADT was administered to 74.5% of Pd-103 patients and 21.8% of I-126 patients before intervention.

Participants filled out International Index of Erectile Function (IIEF-15) questionnaires before treatment, 1 month after treatment, and every 3 months for 2 years, every 6 months up to 5 years, and then annually. The mean follow-up was 60.4 months (range, 48-156).

Potency was assessed in the study using the simplified IIEF-5, with the highest score being 25. Erectile dysfunction before brachytherapy implantation was categorized as “severe” (score, 1-7), “moderate” (score, 8-11), “mild to moderate” (score, 12-16), “mild” (score, 17-21) and “no erectile dysfunction” (score, 22-25).The researchers found that the 2-year actuarial rate of potency preservation was 46.3%, and at 5 years, the rate was 51.4%.

Among the patients younger than 60 years, 41% maintained potency at 2-year follow-up, and 53.8% maintained potency at 5-year follow up. Among those older than 60 years, 47% maintained erectile function at 2 years, and 50.9% maintained potency at 5 years. Multivariate analysis revealed a statistically significant difference in 2- and 5-year potency preservation in men younger than 70 years (43.5%) vs. men older than 70 years (49%; P=.027).

In patients who did not receive ADT before implant, there was a 42.7% rate of potency preservation vs. a 52.1% rate of potency preservation in those who received ADT. This finding was not statistically significant. In the patients who classified themselves as having “severe erectile dysfunction” before implantation, 25% improved their potency after 2 years, whereas 19.2% improved potency after 5 years.

According to study researcher Renée Oismüller, MD, of the SMZ-Ost Donauspital in Vienna, brachytherapy is not only comparable to other therapies, but also more patient-friendly.

“In our experience, brachytherapy used alone is as effective as other established therapies for localized low to intermediate risk prostate cancer,” Oismüller said in a press release. “In addition to allowing the preservation of erectile function in half the men we studied, it has the advantage of involving a short hospitalization of 1 to 2 days. The surgical removal of the entire prostate gland usually involves an average of 4 to 5 days in hospital, so this is of benefit to both patients and health care systems.”

For more information:

Oismüller R. Abstract 0073. Presented at: Congress of the European Society of Radiotherapy and Oncology (ESTRO) 33; April 4-8, 2014; Vienna.

Disclosure: The researchers report no relevant financial disclosures.