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Data Predicts Erectile Function After Cancer Treatment

 |  By cclark@healthleadersmedia.com  
   September 21, 2011

Prostate cancer specialists can now predict a patient's chances of having erectile dysfunction after prostatectomy, external radiotherapy, or brachytherapy, based on data derived from patient-centered outcomes research, a report published in the Journal of the American Medical Association says.

The multi-center clinical trial, led by Mehrdad Alemozaffar, MD, and Martin Sanda, MD, of Beth Israel Deaconess Medical Center and Harvard Medical School, tracked the outcomes from treatments after two years for 1,027 men with early-stage cancers treated at nine academic hospitals. Predictive values were further refined based on patients' pretreatment sexual and disease characteristics.

"The ability to inform individual patients how likely they are to develop erectile dysfunction based on their personal baseline sexual function, cancer severity, individual clinical characteristics and treatment plan has been elusive," the researchers wrote.

"Our findings address this need by providing a validated, broadly applicable framework to predict the probability of long-term, post-treatment erectile dysfunction for individual patients."

Researchers discovered that 24 months later, 35% of men who underwent prostatectomy were able to attain functional erections suitable for intercourse, but that increased to 37% of men who chose radiotherapy and 43% of men who opted for brachytherapy. Those percentages included all patients, including those who did not have erectile function prior to their procedures.

Looking at a subset of patients who had erectile function prior to their procedures, the researchers found that 40% of the men who had their prostates removed reported recovery of sexual function by two years after surgery. But 58% of men who underwent external radiation and 63% of men who had brachytherapy were able to maintain functional erections at the two-year point.

With each option, younger age, fewer co-morbid conditions, lower prostate specific antigen (PSA) levels and lower cancer severity were associated with greater probability of erectile function.

In a Beth Israel statement, Sanda said, "There doesn't need to be a black box of uncertainty when it comes to predicting treatment outcomes. Each patient deserves to understand the expectations for his specific situation so that treatment decisions can be tailored to his individual circumstance."

In a related editorial, Michael Barry, MD, of Massachusetts General Hospital and the Foundation for Informed Medical Decision Making, wrote that the erectile function study helps patients who are likely to survive their disease, and for whom quality of life after treatment is an increasing concern.

"Erectile dysfunction is a common adverse effect (from prostate cancer treatment) many men care about," Barry wrote. "Consider a 60-year-old African American man with a prostate-specific antigen level of 6 ng/mL, a body mass index of 30, and a baseline sexual health-related quality of life score of 83, indicating some sexual dysfunction as well as a tumor Gleason score sum of 6 (3+3).

"This man could learn that men like him would have about a 1 in 3 chance of maintaining erectile function after radical prostatectomy if a nerve-sparing operation could be performed but a 1 in 7 chance without it."

"For most scenarios, the take-away message is that if the patient has chosen surgery, he will more than likely lose erectile function, whereas if he has chosen radiotherapy, he has a better than even chance of preserving it, at least for two years," Barry wrote.

Barry also lamented the Beth Israel Deaconess researchers did not include another consequence of prostate cancer treatment, incontinence, and said he hoped they "develop similar predictive models" for that outcome as well.

The study did have several limitations, in that it relied on patient report and was conducted at academic medical centers where outcomes are not always transferrable to community hospital settings. And its time frame of two years may have been two short to capture erectile function that is restored after a longer time frame after prostatectomy.

And it did not take into consideration the effects of rehabilitation regimens or control for the use of medications or devices. Nevertheless, they wrote, the formula used "indicates that this predictive model is generalizable despite these limitations."

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