medwireNews: Among the potential active treatment options for prostate cancer, external‐beam radiotherapy (EBRT) alone results in the best preservation of sexual function up to 2 years after treatment, population-based study data show.
The worst outcomes were seen among patients who received non-nerve-sparing radical prostatectomy (RP).
Ronald Chen and colleagues from the University of North Carolina at Chapel Hill, USA, say their findings “provide tangible new information to help patients make decisions among the specific types of surgery and RT they face based on each individual’s diagnosis.”
Each of the 835 men with newly diagnosed prostate cancer were assessed for sexual dysfunction using the Prostate Cancer Symptom Indices (PCSI) instrument prior to treatment and at 3, 12, and 24 months follow-up.
Regardless of the treatment given, increased sexual dysfunction (a higher score on a scale of 0–100) occurred at all timepoints post-treatment. At 24 months, the smallest mean increase, of 9.5 points from a baseline of 49.9 points, was seen among the men who received EBRT.
After propensity score matching for age at diagnosis, race, marital status, education, health insurance status, and household income, the researchers found that patients treated with EBRT plus androgen deprivation therapy (ADT), nerve-sparing RP, and non-nerve-sparing RP had significantly worse PCSI scores at all post-treatment time points than those treated with EBRT alone.
For example, at 3 months, the mean PCSI scores were 59.5, 78.2, 80.8, and 83.9 points in the EBRT, EBRT plus ADT, nerve-sparing RP, and non-nerve-sparing RP groups, respectively. At 24 months, the corresponding scores were 59.4, 74.1, 74.4, and 77.8 points.
By contrast, the mean scores for brachytherapy were similar to those for EBRT at 3 months (62.7 vs 59.5 points) and 24 months (66.0 vs 59.4 points) but were significantly higher at 12 months (64.7 vs 54.4 points).
Multivariate analysis confirmed that EBRT with ADT, nerve-sparing RP, and non–nerve-sparing RP all were significantly associated with a decreased likelihood for preserving useful (normal or intermediate) sexual function relative to EBRT alone at 24 months.
Older age and baseline sexual dysfunction score also were significantly associated with sexual function at 24 months.
Using this information, Chen and team created charts showing the probability of preserving useful sexual function at 24 months based on patients’ pretreatment PCSI scores. These charts showed that for EBRT alone, the likelihood of preserving useful sexual function ranged from 14.1% to 70.7% depending on the baseline sexual dysfunction score.
For EBRT with ADT, nerve-sparing RP, and non–nerve-sparing RP the probabilities ranged from 8.4% to 52.3%, 4.7% to 45.3%, and from 4.8% to 34.5%, respectively.
Chen and co-authors conclude in Cancer that “RT alone results in the best preservation of sexual function, and brachytherapy provides similar outcomes” in men with newly diagnosed prostate cancer.
However, they also point out that their study did not include active surveillance as a treatment option but say that previous trials have shown that “sexual dysfunction also gradually worsens over time with active surveillance, and differences are not clinically meaningfully different between RT compared with active treatment at 2 years.”
By Laura Cowen
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