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Keywords:

  • prostate brachytherapy;
  • prostate cancer;
  • erectile dysfunction;
  • IIEF-5

OBJECTIVE

To evaluate the effect of low-dose rate prostate brachytherapy on the sexual health of men with ≥ 7 years of prospective evaluation and optimum sexual function before treatment.

PATIENTS AND METHODS

In all, 223 patients with T1b to T3a prostate cancer and a median (range) age of 66  (50–82) years were treated with permanent seed implantation from November 1990 to March 1998. They were followed for a median (range) of 8.2 (7–14.1) years using prospective quality-of-life measures. Erectile function (EF) was assessed using a physician-assigned score and beginning in June 2000; the validated International Index of EF (IIEF-5) was used as a complementary method to quantify late EF. No adjustment was made to differentiate sexual function with or with no pharmacological intervention for EF. Pearson’s chi-square test and Student’s t-test were used to compare the groups.

RESULTS

Of the 223 men, 131 (59%) had optimal EF before their brachytherapy; of these, 51 (40%) at the last follow-up evaluation were using either a phosphodiesterase type 5 inhibitor (44, 86%), yohimbine (two, 4%) or alprostadil (five, 10%). The age at implantation was highly predictive of current EF; 23 of 25 (92%) men aged 50–59 years had a current EF of ≥ 2; those aged 60–69 and 70–78 years had an EF of ≥2 in 48/75 (64%) and 18/31 (58%) (P = 0.01). A current IIEF-5 score of ≥ 16 also correlated highly with age at implant, i.e. 50–59, 16/25 (64%); 60–69, 20/75 (27%) and 70–78 years, 6/31 (19%) (P < 0.001).

CONCLUSION

Patients aged <60 years and with optimal EF before low-dose rate prostate brachytherapy have a very high probability of long-term EF.