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Clavell-Hernandez J, Wang R. Penile rehabilitation following prostate cancer treatment: review of current literature. Asian J Androl 2016; 17:916-22; discussion 921. [PMID: 25851656 PMCID: PMC4814961 DOI: 10.4103/1008-682x.150838] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Radical prostatectomy (RP) and radiotherapy (RT) are highly effective in improving prostate cancer survival. However, both have a detrimental effect on erectile function (EF). Penile rehabilitation consists of understanding the mechanisms that cause erectile dysfunction (ED) and utilizing pharmacologic agents, devices or interventions to promote male sexual function. For the past decade, many researchers have pursued to define effective treatment modalities to improve ED after prostate cancer treatment. Despite the understanding of the mechanisms and well-established rationale for postprostate treatment penile rehabilitation, there is still no consensus regarding effective rehabilitation programs. This article reviews a contemporary series of trials that assess penile rehabilitation and explore treatment modalities that might play a role in the future. Published data and trials related to penile rehabilitation after RP and RT were reviewed and presented. Although recent trials have shown that most therapies are well-tolerated and aid in some degree on EF recovery, we currently do not have tangible evidence to recommend an irrefutable penile rehabilitation algorithm. However, advancements in research and technology will ultimately create and refine management options for penile rehabilitation.
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Affiliation(s)
| | - Run Wang
- Division of Urology, University of Texas Medical School at Houston, Department of Urology, Houston, Texas; University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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102
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Kerns SL, Dorling L, Fachal L, Bentzen S, Pharoah PDP, Barnes DR, Gómez-Caamaño A, Carballo AM, Dearnaley DP, Peleteiro P, Gulliford SL, Hall E, Michailidou K, Carracedo Á, Sia M, Stock R, Stone NN, Sydes MR, Tyrer JP, Ahmed S, Parliament M, Ostrer H, Rosenstein BS, Vega A, Burnet NG, Dunning AM, Barnett GC, West CML. Meta-analysis of Genome Wide Association Studies Identifies Genetic Markers of Late Toxicity Following Radiotherapy for Prostate Cancer. EBioMedicine 2016; 10:150-63. [PMID: 27515689 PMCID: PMC5036513 DOI: 10.1016/j.ebiom.2016.07.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/08/2016] [Accepted: 07/18/2016] [Indexed: 12/31/2022] Open
Abstract
Nearly 50% of cancer patients undergo radiotherapy. Late radiotherapy toxicity affects quality-of-life in long-term cancer survivors and risk of side-effects in a minority limits doses prescribed to the majority of patients. Development of a test predicting risk of toxicity could benefit many cancer patients. We aimed to meta-analyze individual level data from four genome-wide association studies from prostate cancer radiotherapy cohorts including 1564 men to identify genetic markers of toxicity. Prospectively assessed two-year toxicity endpoints (urinary frequency, decreased urine stream, rectal bleeding, overall toxicity) and single nucleotide polymorphism (SNP) associations were tested using multivariable regression, adjusting for clinical and patient-related risk factors. A fixed-effects meta-analysis identified two SNPs: rs17599026 on 5q31.2 with urinary frequency (odds ratio [OR] 3.12, 95% confidence interval [CI] 2.08-4.69, p-value 4.16×10(-8)) and rs7720298 on 5p15.2 with decreased urine stream (OR 2.71, 95% CI 1.90-3.86, p-value=3.21×10(-8)). These SNPs lie within genes that are expressed in tissues adversely affected by pelvic radiotherapy including bladder, kidney, rectum and small intestine. The results show that heterogeneous radiotherapy cohorts can be combined to identify new moderate-penetrance genetic variants associated with radiotherapy toxicity. The work provides a basis for larger collaborative efforts to identify enough variants for a future test involving polygenic risk profiling.
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Affiliation(s)
- Sarah L Kerns
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leila Dorling
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
| | - Laura Fachal
- Department of Oncology, Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK; Grupo de Medicina Xenómica, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Søren Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland Greenebaum Cancer Center, Baltimore, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Paul D P Pharoah
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
| | - Daniel R Barnes
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
| | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Ana M Carballo
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - David P Dearnaley
- Joint Department of Physics, Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5NG, UK
| | - Paula Peleteiro
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Sarah L Gulliford
- Joint Department of Physics, Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5NG, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London SM2 5NG, UK
| | - Kyriaki Michailidou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
| | - Ángel Carracedo
- Grupo de Medicina Xenómica, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica, Servizo Galego de Saúde (SERGAS), 15706 Santiago de Compostela, Spain
| | - Michael Sia
- Department of Radiation Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Canada
| | - Richard Stock
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nelson N Stone
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew R Sydes
- Cancer and Other Non-Infectious Diseases, MRC Clinical Trials Unit, London WC2B 6NH, UK
| | - Jonathan P Tyrer
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
| | - Shahana Ahmed
- Department of Oncology, Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
| | - Matthew Parliament
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Canada
| | - Harry Ostrer
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Barry S Rosenstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiation Oncology, New York University School of Medicine, New York, NY, USA
| | - Ana Vega
- Grupo de Medicina Xenómica, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain; Department of Radiation Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Canada
| | - Neil G Burnet
- University of Cambridge, Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Alison M Dunning
- Department of Oncology, Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK
| | - Gillian C Barnett
- Department of Oncology, Centre for Cancer Genetic Epidemiology, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK; Department of Oncology, Box 193, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB0 0QQ, UK
| | - Catharine M L West
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester M20 4BX, UK.
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Hegazy MW, Mahmood RI, Al Otaibi MF, Khalil EM. Hypofractionated Volumetric Modulated Arc Radiotherapy with simultaneous Elective Nodal Irradiation is feasible in prostate cancer patients: A single institution experience. J Egypt Natl Canc Inst 2016; 28:101-10. [DOI: 10.1016/j.jnci.2016.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 11/16/2022] Open
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Storås AH, Sanda MG, Boronat OG, Chang P, Patil D, Crociani C, Suarez JF, Cvancarova M, Loge JH, Fosså SD. Erectile Dysfunction and Sexual Problems Two to Three Years After Prostatectomy Among American, Norwegian, and Spanish Patients. Clin Genitourin Cancer 2016; 14:e265-73. [DOI: 10.1016/j.clgc.2015.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/10/2015] [Accepted: 10/17/2015] [Indexed: 11/25/2022]
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Changes in penile bulb dose when using the Clarity transperineal ultrasound probe: A planning study. Pract Radiat Oncol 2016; 6:e337-e344. [PMID: 27161954 DOI: 10.1016/j.prro.2016.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The Clarity system allows monitoring of intrafraction target organ movements in external beam radiation therapy of prostate cancer by using transperineal ultrasound. The probe positioning at the perineum could lead to a compression and shift of the penile bulb (PB) toward the high-dose region. Dose to the PB has been reported to be associated with the risk of posttreatment erectile dysfunction. This planning study reports on PB translations and changes in volume and dose when applying the transperineal ultrasound probe. METHODS AND MATERIALS For 10 patients treated with external beam radiation therapy for prostate cancer between 2013 and 2014, a planning computed tomography scan with and without the ultrasound probe in place was acquired. The planning target volume and organs at risk including the PB were contoured in the computed tomography scan with and without the probe. Radiation therapy plans for both scenarios were calculated. In a second step, for planning with the probe in position, an additional objective for improved sparing of the PB was introduced. RESULTS The median PB volume was 5.5 mL (range, 3.8-7.1 mL) without the probe and 3.5 mL (range, 2.0-5.8 mL) with the probe. The median shift of the PB was 1 mm in the posterior (range, 3 mm posterior-2 mm anterior) and 6 mm in the superior direction (range, 0-14 mm superior), with no relevant shift of the prostate. The median mean dose in 95% of the PB was 34.1 Gy (range, 6.0-50.4 Gy), 48.3 Gy (range, 7.2-56.8 Gy), and 39.4 Gy (range, 5.6-51.3 Gy) for plans without probe, with probe, and with probe and additional planning objective, respectively. CONCLUSIONS Dose to the PB increased when using the transperineal probe. After introducing an additional plan-optimization objective for PB sparing, dose-volume parameters were below Quantitative Analyses of Normal Tissue Effects in the Clinic thresholds for all but one patient.
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106
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Vessel-sparing radiation and functional anatomy-based preservation for erectile function after prostate radiotherapy. Lancet Oncol 2016; 17:e198-208. [DOI: 10.1016/s1470-2045(16)00063-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/06/2016] [Accepted: 01/21/2016] [Indexed: 12/14/2022]
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107
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Baseline status and dose to the penile bulb predict impotence 1 year after radiotherapy for prostate cancer. Strahlenther Onkol 2016; 192:297-304. [DOI: 10.1007/s00066-016-0964-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/24/2016] [Indexed: 11/27/2022]
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Landoni V, Fiorino C, Cozzarini C, Sanguineti G, Valdagni R, Rancati T. Predicting toxicity in radiotherapy for prostate cancer. Phys Med 2016; 32:521-32. [PMID: 27068274 DOI: 10.1016/j.ejmp.2016.03.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/15/2016] [Accepted: 03/02/2016] [Indexed: 02/08/2023] Open
Abstract
This comprehensive review addresses most organs at risk involved in planning optimization for prostate cancer. It can be considered an update of a previous educational review that was published in 2009 (Fiorino et al., 2009). The literature was reviewed based on PubMed and MEDLINE database searches (from January 2009 up to September 2015), including papers in press; for each section/subsection, key title words were used and possibly combined with other more general key-words (such as radiotherapy, dose-volume effects, NTCP, DVH, and predictive model). Publications generally dealing with toxicity without any association with dose-volume effects or correlations with clinical risk factors were disregarded, being outside the aim of the review. A focus was on external beam radiotherapy, including post-prostatectomy, with conventional fractionation or moderate hypofractionation (<4Gy/fraction); extreme hypofractionation is the topic of another paper in this special issue. Gastrointestinal and urinary toxicity are the most investigated endpoints, with quantitative data published in the last 5years suggesting both a dose-response relationship and the existence of a number of clinical/patient related risk factors acting as dose-response modifiers. Some results on erectile dysfunction, bowel toxicity and hematological toxicity are also presented.
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Affiliation(s)
- Valeria Landoni
- Medical Physics, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Claudio Fiorino
- Medical Physics, Raffaele Scientific Institute IRCCS, Milan, Italy
| | | | | | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Ramsay CR, Adewuyi TE, Gray J, Hislop J, Shirley MDF, Jayakody S, MacLennan G, Fraser C, MacLennan S, Brazzelli M, N'Dow J, Pickard R, Robertson C, Rothnie K, Rushton SP, Vale L, Lam TB. Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation. Health Technol Assess 2016; 19:1-490. [PMID: 26140518 DOI: 10.3310/hta19490] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND For people with localised prostate cancer, active treatments are effective but have significant side effects. Minimally invasive treatments that destroy (or ablate) either the entire gland or the part of the prostate with cancer may be as effective and cause less side effects at an acceptable cost. Such therapies include cryotherapy, high-intensity focused ultrasound (HIFU) and brachytherapy, among others. OBJECTIVES This study aimed to determine the relative clinical effectiveness and cost-effectiveness of ablative therapies compared with radical prostatectomy (RP), external beam radiotherapy (EBRT) and active surveillance (AS) for primary treatment of localised prostate cancer, and compared with RP for salvage treatment of localised prostate cancer which has recurred after initial treatment with EBRT. DATA SOURCES MEDLINE (1946 to March week 3, 2013), MEDLINE In-Process & Other Non-Indexed Citations (29 March 2013), EMBASE (1974 to week 13, 2013), Bioscience Information Service (BIOSIS) (1956 to 1 April 2013), Science Citation Index (1970 to 1 April 2013), Cochrane Central Register of Controlled Trials (CENTRAL) (issue 3, 2013), Cochrane Database of Systematic Reviews (CDSR) (issue 3, 2013), Database of Abstracts of Reviews of Effects (DARE) (inception to March 2013) and Health Technology Assessment (HTA) (inception to March 2013) databases were searched. Costs were obtained from NHS sources. REVIEW METHODS Evidence was drawn from randomised controlled trials (RCTs) and non-RCTs, and from case series for the ablative procedures only, in people with localised prostate cancer. For primary therapy, the ablative therapies were cryotherapy, HIFU, brachytherapy and other ablative therapies. The comparators were AS, RP and EBRT. For salvage therapy, the ablative therapies were cryotherapy and HIFU. The comparator was RP. Outcomes were cancer related, adverse effects (functional and procedural) and quality of life. Two reviewers extracted data and carried out quality assessment. Meta-analysis used a Bayesian indirect mixed-treatment comparison. Data were incorporated into an individual simulation Markov model to estimate cost-effectiveness. RESULTS The searches identified 121 studies for inclusion in the review of patients undergoing primary treatment and nine studies for the review of salvage treatment. Cryotherapy [3995 patients; 14 case series, 1 RCT and 4 non-randomised comparative studies (NRCSs)], HIFU (4000 patients; 20 case series, 1 NRCS) and brachytherapy (26,129 patients; 2 RCTs, 38 NRCSs) studies provided limited data for meta-analyses. All studies were considered at high risk of bias. There was no robust evidence that mortality (4-year survival 93% for cryotherapy, 99% for HIFU, 91% for EBRT) or other cancer-specific outcomes differed between treatments. For functional and quality-of-life outcomes, the paucity of data prevented any definitive conclusions from being made, although data on incontinence rates and erectile dysfunction for all ablative procedures were generally numerically lower than for non-ablative procedures. The safety profiles were comparable with existing treatments. Studies reporting the use of focal cryotherapy suggested that incontinence rates may be better than for whole-gland treatment. Data on AS, salvage treatment and other ablative therapies were too limited. The cost-effectiveness analysis confirmed the uncertainty from the clinical review and that there is no technology which appears superior, on the basis of current evidence, in terms of average cost-effectiveness. The probabilistic sensitivity analyses suggest that a number of ablative techniques are worthy of further research. LIMITATIONS The main limitations were the quantity and quality of the data available on cancer-related outcomes and dysfunction. CONCLUSIONS The findings indicate that there is insufficient evidence to form any clear recommendations on the use of ablative therapies in order to influence current clinical practice. Research efforts in the use of ablative therapies in the management of prostate cancer should now be concentrated on the performance of RCTs and the generation of standardised outcomes. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002461. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Joanne Gray
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Jenni Hislop
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark D F Shirley
- School of Biology, Newcastle University, Newcastle upon Tyne, UK
| | | | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sara MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Robert Pickard
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
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Voznesensky M, Annam K, Kreder KJ. Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer. J Oncol Pract 2016; 12:297-304. [PMID: 27072383 PMCID: PMC5015452 DOI: 10.1200/jop.2016.010678] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Cancer can cause sexual adverse effects by direct and indirect pathways. It can involve sexual organs, indirectly affect body image, or cause fatigue or depression with subsequent effects on libido. Erectile dysfunction (ED), the inability to obtain or maintain an erection firm enough for sexual intercourse, can also result from adverse effects of cancer treatment, such as fatigue, pain, or anxiety about therapy. In addition, depressed feelings about having cancer can affect sexuality, causing a range of signs and symptoms that can lead to ED. Chemotherapy, hormone therapy, surgery, and radiation can all cause sexual adverse effects. Additional factors that play a role include patient age and degree of ED before starting cancer treatment. In this article, we discuss how chemotherapy, hormone therapy, surgery, and radiation affect erectile function as well as possible treatment options for ED.
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111
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Rossi MS, Moschini M, Bianchi M, Gandaglia G, Fossati N, Dell'Oglio P, Schiavina R, Brunocilla E, Farina E, Picozzi M, Salonia A, Montorsi F, Briganti A. Erectile Function Recovery After Nerve-Sparing Radical Prostatectomy for Prostate Cancer: Is Back to Baseline Status Enough for Patient Satisfaction? J Sex Med 2016; 13:669-78. [PMID: 27045263 DOI: 10.1016/j.jsxm.2016.02.160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/30/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Several definitions of erectile function (EF) recovery after bilateral nerve-sparing radical prostatectomy (BNSRP) have been proposed based on the results of the International Index of EF (IIEF). AIM We aimed at evaluating overall satisfaction (OS) after BNSRP according to the ability to achieve the pretreatment EF. METHODS We evaluated data of 652 patients treated with BNSRP for clinically localized prostate cancer (PCa). Erectile dysfunction (ED) was classified according to the IIEF-EF domain score. Return to baseline EF was defined as patients who reached the same preoperative ED category during the 3-year follow-up. Cox regression analyses were fitted to predict return to baseline IIEF-EF and to predict OS defined according to the IIEF-OS in the overall population. Logistic regression analyses were performed to analyze OS in men who reached the back to baseline status. MAIN OUTCOME MEASURES The outcome of the study was to evaluate back to baseline EF status and to correlate it with postoperative OS. RESULTS Preoperative satisfaction was reported by 218 (33.4%) patients. Postoperative satisfaction was achieved by 103 patients. Overall, 383 patients were able to achieve the preoperative IIEF-EF score. However, only 26.9% reported being satisfied. Age and preoperative IIEF-EF score were significantly associated with baseline IIEF-EF recovery (all P ≤ .02). Patients who were able to return to baseline IIEF-EF were more likely to be satisfied (P < .001). Time elapsed between surgery and achievement of baseline IIEF-EF was significantly associated with OS (P < .001). Among patients who were able to achieve the baseline IIEF-EF score, a preoperative IIEF-EF of 22-25 and 26-30 was significantly associated with postoperative satisfaction (all P < .001). CONCLUSION After BNSRP, reaching the baseline IIEF-EF score is not always sufficient to obtain patient satisfaction. Only patients with a preoperative IIEF-EF ≥22 who reached the baseline score after surgery considered themselves satisfied. This should be taken into account in preoperative patient counseling.
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Affiliation(s)
- Martina Sofia Rossi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Moschini
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Doctorate Research Program, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Marco Bianchi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Doctorate Research Program, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Dell'Oglio
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Farina
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marta Picozzi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
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Dickinson L, Arya M, Afzal N, Cathcart P, Charman SC, Cornaby A, Hindley RG, Lewi H, McCartan N, Moore CM, Nathan S, Ogden C, Persad R, van der Meulen J, Weir S, Emberton M, Ahmed HU. Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort. Eur Urol 2016; 70:668-674. [PMID: 26951947 DOI: 10.1016/j.eururo.2016.02.054] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 02/18/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is a minimally-invasive treatment for nonmetastatic prostate cancer. OBJECTIVE To report medium-term outcomes in men receiving primary whole-gland HIFU from a national multi-centre registry cohort. DESIGN, SETTING, AND PARTICIPANTS Five-hundred and sixty-nine patients at eight hospitals were entered into an academic registry. INTERVENTION Whole-gland HIFU (Sonablate 500) for primary nonmetastatic prostate cancer. Redo-HIFU was permitted as part of the intervention. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Our primary failure-free survival outcome incorporated no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer-specific mortality. Secondary outcomes included adverse events and genitourinary function. RESULTS AND LIMITATIONS Mean age was 65 yr (47-87 yr). Median prostate-specific antigen was 7.0 ng/ml (interquartile range 4.4-10.2). National Comprehensive Cancer Network low-, intermediate-, and high-risk disease was 161 (28%), 321 (56%), and 81 (14%), respectively. One hundred and sixty three of 569 (29%) required a total of 185 redo-HIFU procedures. Median follow-up was 46 (interquartile range 23-61) mo. Failure-free survival at 5 yr after first HIFU was 70% (95% confidence interval [CI]: 64-74). This was 87% (95% CI: 78-93), 63% (95% CI: 56-70), and 58% (95% CI: 32-77) for National Comprehensive Cancer Network low-, intermediate-, and high-risk groups, respectively. Fifty eight of 754 (7.7%) had one urinary tract infection, 22/574 (2.9%) a recurrent urinary tract infection, 22/754 (3%) epididymo-orchitis, 227/754 (30%) endoscopic interventions, 1/754 (0.13%) recto-urethral fistula, and 1/754 (0.13%) osteitis pubis. Of 206 known to be pad-free pre-HIFU, 183/206 (88%) remained pad free, and of 236 with good baseline erectile function, 91/236 (39%) maintained good function. The main limitation is lack of long-term data. CONCLUSIONS Whole-gland HIFU is a repeatable day-case treatment that confers low rates of urinary incontinence. Disease control at a median of just under 5 yr of follow-up demonstrates its potential as a treatment for nonmetastatic prostate cancer. Endoscopic interventions and erectile dysfunction rates are similar to other whole-gland treatments. PATIENT SUMMARY In this report we looked at the 5-yr outcomes following whole-gland high-intensity focused ultrasound treatment for prostate cancer and found that cancer control was acceptable with a low risk of urine leakage. However, risk of erectile dysfunction and further operations was similar to other whole-gland treatments like surgery and radiotherapy.
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Affiliation(s)
- Louise Dickinson
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Manit Arya
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK; Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Naveed Afzal
- Department of Urology, Dorset County Hospital, Dorchester, UK
| | - Paul Cathcart
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Susan C Charman
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Andrew Cornaby
- Department of Urology, Dorset County Hospital, Dorchester, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke Hospital, Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | - Henry Lewi
- Department of Urology, Broomfield Hospital, Mid Essex NHS Trust, Chelmsford, UK
| | - Neil McCartan
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Senthil Nathan
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Chris Ogden
- Department of Academic Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Raj Persad
- Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Shraddha Weir
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Hashim U Ahmed
- Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
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Baker H, Wellman S, Lavender V. Functional Quality-of-Life Outcomes Reported by Men Treated for Localized Prostate Cancer: A Systematic Literature Review. Oncol Nurs Forum 2016; 43:199-218. [DOI: 10.1188/16.onf.199-218] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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114
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Prostate cancer radiation therapy: A physician’s perspective. Phys Med 2016; 32:438-45. [DOI: 10.1016/j.ejmp.2016.02.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/27/2016] [Accepted: 02/17/2016] [Indexed: 02/07/2023] Open
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115
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Canalichio K, Jaber Y, Wang R. Surgery and hormonal treatment for prostate cancer and sexual function. Transl Androl Urol 2016; 4:103-9. [PMID: 26816817 PMCID: PMC4708130 DOI: 10.3978/j.issn.2223-4683.2015.01.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Prostate cancer (PC) is one of the most common cancers effecting men today. With earlier detection and improvements in available treatment modalities, there still remains significant morbidity associated with the treatment of PC. Male sexual health and erectile function are greatly impacted by these therapies and remain a concern to PC survivors. This article reviews the current literature on male sexual health following radical prostatectomy (RP) or androgen ablation therapy for PC. Each treatment modality affects male sexual function to an appreciable level, although certain patients have better outcomes if they have preoperative potency, are younger, or have nerve-sparing surgery. There is a delayed recovery up to 2 years seen in erectile function following RP. With androgen deprivation therapy (ADT), attempts can be made at different administration strategies and exercise may possibly play a role in maintaining erectile function. Penile rehabilitation protocols attempt to protect erectile function immediately following therapy through different modalities, although no one approach has been agreed upon.
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Affiliation(s)
- Katie Canalichio
- 1 Division of Urology, University of Texas Health Science Center, Houston, TX 77030, USA ; 2 Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yasmeen Jaber
- 1 Division of Urology, University of Texas Health Science Center, Houston, TX 77030, USA ; 2 Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Run Wang
- 1 Division of Urology, University of Texas Health Science Center, Houston, TX 77030, USA ; 2 Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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116
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Cassidy R, Yang X, Liu T, Thomas M, Nour S, Jani A. Neurovascular bundle–sparing radiotherapy for prostate cancer using MRI-CT registration: A dosimetric feasibility study. Med Dosim 2016; 41:339-343. [DOI: 10.1016/j.meddos.2016.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/17/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
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117
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Jenkins LC, Mulhall JP. Impact of Prostate Cancer Treatments on Sexual Health. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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118
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Morgia G, Castelli T, Privitera S, Al-Nakib C, Favilla V, Marchese F, Cimino S, Russo GI. Association between long-term erectile dysfunction and biochemical recurrence after permanent seed I(125) implant brachytherapy for prostate cancer. A longitudinal study of a single-institution. Aging Male 2016; 19:15-9. [PMID: 26376010 DOI: 10.3109/13685538.2015.1083546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We aimed to investigate the predictive factor of erectile dysfunction (ED) in prostate cancer (PCa) patients who underwent low-dose permanent I(125) seed implant brachytherapy and to investigate if ED could represent a patient's reported outcome measures (PROMs) of efficacy of BT and indirectly associated with biochemical recurrence free survival (BRFS). From 2000 to 2012, 176 consecutive patients with low-risk PCa underwent BT. ED was evaluated with the International Index of Erectile Function (IIEF-5). Cox regression analysis was performed to assess significant predictors of mild-to-severe ED and BRFS after BT, including covariates. The 10-year actuarial rate of ED was 66%. Subjects with severe ED had higher values of D90 (183.0 versus 177.0; p < 0.05) and V100% (40.1 versus 31.4; p < 0.05) compared with normal. At the multivariate logistic regression analysis, D90 (OR: 1.10; p < 0.05) was an independent predictor of ED. Multivariate Cox-regression analysis did not demonstrate significant association between erectile preservation and biochemical recurrence (BCR) after 10 years of follow up (HR: 2.15; p = 0.20), while D90 ≤ 180 Gy independently predicted BCR (HR: 4.65; [95%CI: 1.25-17.34]; p < 0.05). Erectile preservation should be addressed as valuable PROMs after permanent seed I(125) implant, but it is not associated with better BRFS.
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Affiliation(s)
- Giuseppe Morgia
- a Department of Urology , University of Catania , Catania , Italy
| | - Tommaso Castelli
- a Department of Urology , University of Catania , Catania , Italy
| | | | - Chaled Al-Nakib
- a Department of Urology , University of Catania , Catania , Italy
| | - Vincenzo Favilla
- a Department of Urology , University of Catania , Catania , Italy
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119
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Putora PM, Engeler D, Haile SR, Graf N, Buchauer K, Schmid HP, Plasswilm L. Erectile function following brachytherapy, external beam radiotherapy, or radical prostatectomy in prostate cancer patients. Strahlenther Onkol 2015; 192:182-9. [PMID: 26713323 DOI: 10.1007/s00066-015-0928-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 11/20/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE For localized prostate cancer, treatment options include external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT). Erectile dysfunction (ED) is a common side-effect. Our aim was to evaluate penile erectile function (EF) before and after BT, EBRT, or RP using a validated self-administered quality-of-life survey from a prospective registry. MATERIAL AND METHODS Analysis included 478 patients undergoing RP (n = 252), EBRT (n = 91), and BT (n = 135) with at least 1 year of follow-up and EF documented using IIEF-5 scores at baseline, 6 weeks, 6 months, 1 year, and annually thereafter. RESULTS Differences among treatments were most pronounced among patients with no or mild initial ED (IIEF-5 ≥ 17). Overall, corrected for baseline EF and age, BT was associated with higher IIEF-5 scores than RP (+ 7.8 IIEF-5 score) or EBRT (+ 3.1 IIEF-5 score). EBRT was associated with better IIEF-5 scores than RP (+ 4.7 IIEF-5 score). In patients undergoing EBRT or RP with bilateral nerve sparing (NS), recovery of EF was observed and during follow-up, the differences to BT were not statistically significant. Overall age had a negative impact on EF preservation (corrected for baseline IIEF). CONCLUSION In our series, EF was adversely affected by each treatment modality. Considered overall, BT provided the best EF preservation in comparison to EBRT or RP.
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Affiliation(s)
- P M Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - D Engeler
- Department of Urology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - S R Haile
- Clinical Trials Unit, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - N Graf
- Clinical Trials Unit, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - K Buchauer
- Department of Radiation Oncology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - H P Schmid
- Department of Urology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - L Plasswilm
- Department of Radiation Oncology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
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121
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Lopez A, Zlatev DV, Mach KE, Bui D, Liu JJ, Rouse RV, Harris T, Leppert JT, Liao JC. Intraoperative Optical Biopsy during Robotic Assisted Radical Prostatectomy Using Confocal Endomicroscopy. J Urol 2015; 195:1110-1117. [PMID: 26626214 DOI: 10.1016/j.juro.2015.10.182] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 01/16/2023]
Abstract
PURPOSE Intraoperative optical biopsy technologies may aid in the identification of important anatomical landmarks and improve surgical outcomes of robotic assisted radical prostatectomy. We evaluate the feasibility of confocal laser endomicroscopy during robotic assisted radical prostatectomy. MATERIALS AND METHODS A total of 21 patients with biopsy proven prostate cancer scheduled for robotic assisted radical prostatectomy were recruited. After intravenous administration of fluorescein 15 patients underwent in vivo intraoperative confocal laser endomicroscopy of prostatic and periprostatic structures using a 2.6 or 0.85 mm imaging probe. Standard robotic instruments were used to grasp and maneuver the confocal laser endomicroscopy probes for image acquisition. Confocal laser endomicroscopy imaging was performed ex vivo on fresh prostate specimens from 20 patients. Confocal video sequences acquired in vivo and ex vivo were reviewed and analyzed, with additional image processing using a mosaicing algorithm. Processed confocal images were compared with standard hematoxylin and eosin analysis of imaged regions. RESULTS Confocal laser endomicroscopy was successfully integrated with robotic surgery, including co-registration of confocal video sequences with white light and probe handling with standard robotic instrumentation. Intraoperative confocal laser endomicroscopy imaging of the neurovascular bundle before and after nerve sparing dissection revealed characteristic features including dynamic vascular flow and intact axon fibers. Ex vivo confocal imaging of the prostatic parenchyma demonstrated normal prostate glands, stroma and prostatic carcinoma. CONCLUSIONS We report the initial feasibility of optical biopsy of prostatic and periprostatic tissue during robotic assisted radical prostatectomy. Image guidance and tissue interrogation using confocal laser endomicroscopy offer a new intraoperative imaging method that has the potential to improve the functional and oncologic outcomes of prostate cancer surgery.
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Affiliation(s)
- Aristeo Lopez
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Dimitar V Zlatev
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Kathleen E Mach
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Daniel Bui
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Jen-Jane Liu
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Robert V Rouse
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.,Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
| | - Theodore Harris
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
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122
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Survivorship and Improving Quality of Life in Men with Prostate Cancer. Eur Urol 2015; 68:374-83. [DOI: 10.1016/j.eururo.2015.04.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/16/2015] [Indexed: 11/18/2022]
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123
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Lee JK, Assel M, Thong AE, Sjoberg DD, Mulhall JP, Sandhu J, Vickers AJ, Ehdaie B. Unexpected Long-term Improvements in Urinary and Erectile Function in a Large Cohort of Men with Self-reported Outcomes Following Radical Prostatectomy. Eur Urol 2015; 68:899-905. [PMID: 26293181 DOI: 10.1016/j.eururo.2015.07.074] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/31/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is generally assumed that if a man does not regain urinary continence or erectile function within 12 mo of radical prostatectomy (RP), then the chance of subsequent recovery is low. OBJECTIVE To determine the probability of achieving good urinary function (UF) or erectile function (EF) up to 48 mo postoperatively in men who reported poor UF or EF at 12 mo after RP. DESIGN, SETTING, AND PARTICIPANTS We identified 3187 patients who underwent RP from 2007 through 2013 at a tertiary institution and had extended multidisciplinary follow-up with patient-reported UF and EF scores at ≥12 mo. INTERVENTION Open or minimally invasive RP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcome was good UF as defined by a urinary score ≥17 (range: 0-21) or good EF as defined by a modified International Index of Erectile Function-6 score ≥22 (range: 1-30). The probability of functional recovery beyond 12 mo was determined by Kaplan-Meier analyses. RESULTS AND LIMITATIONS Among patients incontinent at 12 mo, the probability of achieving good UF at 24, 36, and 48 mo was 30%, 49%, and 59%. In patients experiencing erectile dysfunction at 12 mo, the probability of recovering EF at 24, 36, and 48 mo was 22%, 32%, and 40%. On multivariable analyses, 12-mo functional score and age were associated with recovery, but only score was consistently significant. CONCLUSIONS Men with incontinence or erectile dysfunction at 12 mo have higher than anticipated rates of subsequent functional improvement. Probability of recovery is strongly influenced by score at 12 mo. Further research should address the impact of ongoing multidisciplinary follow-up care on our observed rates of recovery. PATIENT SUMMARY Many prostate cancer patients continue to recover urinary and erectile function after 12 mo. The level of functional recovery by 12 mo is associated with long-term recovery and should be discussed by the physician and patient when deciding on rehabilitative interventions.
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Affiliation(s)
- Justin K Lee
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alan E Thong
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaspreet Sandhu
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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124
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Lindau ST, Abramsohn EM, Matthews AC. A manifesto on the preservation of sexual function in women and girls with cancer. Am J Obstet Gynecol 2015; 213:166-74. [PMID: 25818667 PMCID: PMC4692159 DOI: 10.1016/j.ajog.2015.03.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 02/19/2015] [Accepted: 03/19/2015] [Indexed: 12/17/2022]
Abstract
Malignancies that affect females who survive cancer commonly originate in, invade, and/or metastasize to the sexual organs, including the ovaries, uterine corpus, uterine cervix, vagina, vulva, fallopian tubes, anus, rectum, breast(s), and brain. Females comprise most of the population (in number and proportion) with cancers that directly affect the sexual organs. Most females in the age groups most commonly affected by cancer are sexually active in the year before diagnosis, which includes most menopausal women who have a partner. Among female cancer survivors, the vast majority have cancers that are treated with local or systemic therapies that result in removal, compromise, or destruction of the sexual organs. Additionally, female cancer survivors often experience abrupt or premature onset of menopause, either directly with surgery, radiation, or other treatments or indirectly through disruption of female sex hormone or other neuroendocrine physiology. For many female patients, cancer treatment has short-term and long-lasting effects on other aspects of physical, psychological, and social functioning that can interfere with normal sexual function; these effects include pain, depression, and anxiety; fatigue and sleep disruption; changes in weight and body image; scars, loss of normal skin sensation, and other skin changes; changes in bodily odors; ostomies and loss of normal bowel and bladder function; lymphedema, and strained intimate partnerships and other changes in social roles. In spite of these facts, female patients who are treated for cancer receive insufficient counseling, support, or treatment to preserve or regain sexual function after cancer treatment.
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Affiliation(s)
- Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL; Department of Medicine-Geriatrics, University of Chicago, Chicago, IL.
| | - Emily M Abramsohn
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Amber C Matthews
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
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125
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Abstract
Through unique physical dose deposition properties, proton beam therapy (PBT) potentiates radiation dose escalation to target tissue while minimizing radiation exposure to nontarget organs. Proton beam therapy has been used to treat prostate cancer for several decades; however, access to proton centers has been restricted to the limited number of proton centers. Because of recent enhancements in availability and treatment delivery systems, interest in PBT has been burgeoning among oncologists, industry experts, and prostate cancer patients. As a result, the importance of understanding the collective experience to date and technical aspects of PBT delivery has become increasingly important in cancer medicine. This review article is intended to discuss the fundamentals of PBT treatment, critically review the literature on PBT for localized prostate cancer, and describe the continued development of proton beam technology for the treatment of prostate cancer.
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Affiliation(s)
- Thomas J Pugh
- From the Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX
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126
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Østby-Deglum M, Brennhovd B, Axcrona K, Fosså SD, Dahl AA. A comparative study of erectile function and use of erectile aids in high-risk prostate cancer patients after robot-assisted laparoscopic prostatectomy. Scand J Urol 2015; 49:433-439. [DOI: 10.3109/21681805.2015.1042038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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127
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Kadıoğlu A, Ortaç M, Dinçer M, Brock G. Tadalafil therapy for erectile dysfunction following prostatectomy. Ther Adv Urol 2015; 7:146-51. [PMID: 26161145 PMCID: PMC4485415 DOI: 10.1177/1756287215576626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Erectile dysfunction is a major complication affecting the quality of life of patients and partners after radical prostatectomy. Evolving evidence suggests that early penile rehabilitation may provide better erectile function after surgery. Phosphodiesterase type 5 (PDE-5) inhibitors are routinely considered a first-line treatment option in most algorithms for penile rehabilitation owing to their efficacy, ease of use, wide availability and minimal morbidity. Tadalafil is a long-acting, potent PDE-5 inhibitor for erectile dysfunction, with demonstrated effect in animal studies at preserving penile smooth muscle content and prevention of fibrosis of cavernosal tissue. This article evaluates the existing literature on tadalafil and critically analyzes its impact on erectile function following radical prostatectomy.
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Affiliation(s)
- Ateş Kadıoğlu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mazhar Ortaç
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Murat Dinçer
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gerald Brock
- University of Western Ontario, 268 Grosvenor St, London, Ontario, Canada N6A4V2
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128
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Burnett AL. Racial Disparities in Sexual Dysfunction Outcomes After Prostate Cancer Treatment: Myth or Reality? J Racial Ethn Health Disparities 2015; 3:154-9. [PMID: 26896115 DOI: 10.1007/s40615-015-0126-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/13/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
Abstract
Among diverse subject areas in the field of prostate cancer management, treatment-related sexual dysfunction complications persist today as a significant potential problem for all men receiving treatment for this disease. The conjecture that African-American men are disproportionately affected by this problem among ethnic groups is not trivial and warrants attention in view of the possibility that its risk profile, whether real or perceived, may influence clinical management decisions impacting survival outcomes in this high-prostate cancer-risk population. A literature review was performed to define the occurrence and significance of sexual dysfunction after prostate cancer treatment in African-American men, with an emphasis on clinically localized treatment. Data retrieved from population-based as well as single-center investigations are conflicting with regard to the extent and quality of life relevance of sexual dysfunction following prostate cancer treatments in African-American men, relative to that of ethnically different counterparts. Some reports suggest a relatively greater trend in African-American men than other ethnic groups toward obtaining clinical management for sexual dysfunction and experiencing psychosocial effects from it, lending additional support for the possibly greater effect of this problem in African-American men. Although further studies are needed to define sexual dysfunction after prostate cancer treatment and ascertain its bother and impact on quality of life in African-American men, survivorship care that encompasses sexual dysfunction management should proceed with appropriate attention given to cultural, educational, and psychosocial variables.
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Affiliation(s)
- Arthur L Burnett
- Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA.
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Ong WL, McLachlan H, Millar JL. Prevalence of Baseline Erectile Dysfunction (ED) in an Australian Cohort of Men with Localized Prostate Cancer. J Sex Med 2015; 12:1267-74. [PMID: 25847707 DOI: 10.1111/jsm.12867] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a common complication following prostate cancer treatment. Post-treatment erectile function (EF) preservation is strongly dependent on the baseline EF prior to treatment. AIM To assess the baseline EF among patients with localized prostate cancer, and the factors associated with baseline EF. METHODS All men with clinically localized prostate cancer had their baseline EF assessed prior to brachytherapy at our institution. Six hundred ninety-nine men who completed the International Index of Erectile Function five-item questionnaires pre-treatment between 2001 and 2013 were included in the study. Data on patient factors (medical comorbidities and smoking history) and prostate cancer clinicopathological characteristics were recorded. Ordinal logistic regressions were used to estimate the effects of each variable on the severity of ED. MAIN OUTCOME MEASURES Baseline EF among men with localized prostate cancer, and factors associated with ED. RESULTS Prior to permanent seed brachytherapy, 335 (48%) patients reported no ED, 129 (17%) mild ED, 42 (6%) mild-moderate ED, 37 (5%) moderate ED, and 165 (24%) severe ED. In multivariate analyses, age, diabetes, and hypertension remained to be independently associated with ED, with diabetes most strongly associated with worse ED (odds ratio = 2.6; 95% confidence interval = 1.3-5.3). CONCLUSIONS ED is common among patients with localized prostate cancer prior to any curative treatment. Assessment of baseline ED is important prior to curative treatment of prostate cancer in order to offer appropriate advise on likelihood of EF preservation post-treatment and avoid patient dissatisfaction with treatment outcomes due to unrealistic expectations.
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Affiliation(s)
- Wee Loon Ong
- William Buckland Radiation Oncology Service, Alfred Health, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Hamish McLachlan
- William Buckland Radiation Oncology Service, Alfred Health, Melbourne, Vic., Australia
| | - Jeremy L Millar
- William Buckland Radiation Oncology Service, Alfred Health, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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Abstract
Many therapies for erectile dysfunction (ED) after prostate cancer treatment improve erectile firmness, yet, most couples stop using aids within 1-2 years. Patients and partners who expect immediate and complete success with their first ED treatment can be demoralized when they experience treatment failure, which contributes to reticence to explore other ED aids. Comprehensive patient education should improve sustainability and satisfaction with ED treatments. Pre-emptive and realistic information should be provided to couples about the probability of recovering natural erections. Beginning intervention early and using a couple-based approach is ideal. Recommendations are provided about the timing of ED treatment, the order of aid introduction, and combination therapies. Renegotiation of sexual activity is an essential part of sexual adaptation. From the outset of therapy, couples should be encouraged to broaden their sexual repertoire, incorporate erection-independent sexual activities, and continue to be sexual despite ED and reduced libido.
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131
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Belew D, Klaassen Z, Lewis RW. Intracavernosal Injection for the Diagnosis, Evaluation, and Treatment of Erectile Dysfunction: A Review. Sex Med Rev 2015; 3:11-23. [DOI: 10.1002/smrj.35] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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132
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Salz T, Baxi SS, Raghunathan N, Onstad EE, Freedman AN, Moskowitz CS, Dalton SO, Goodman KA, Johansen C, Matasar MJ, de Nully Brown P, Oeffinger KC, Vickers AJ. Are we ready to predict late effects? A systematic review of clinically useful prediction models. Eur J Cancer 2015; 51:758-66. [PMID: 25736818 DOI: 10.1016/j.ejca.2015.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND After completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period. PURPOSE To identify and describe all models that predict the risk of late effects and could be used in clinical practice. DATA SOURCES We searched Medline through April 2014. STUDY SELECTION Studies describing models that (1) predicted the absolute risk of a late effect present at least 1 year post-treatment, and (2) could be used in a clinical setting. DATA EXTRACTION Three authors independently extracted data pertaining to patient characteristics, late effects, the prediction model and model evaluation. DATA SYNTHESIS Across 14 studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphoedema, psychological morbidity, cardiomyopathy or heart failure and cardiac event after breast cancer; swallowing dysfunction after head and neck cancer; breast cancer after Hodgkin lymphoma and thyroid cancer after childhood cancer. Of these, four late effects are persistent effects of treatment and five appear after a latent period. Two studies were externally validated. Six studies were designed to inform decisions about treatment rather than survivorship care. Nomograms were the most common clinical output. CONCLUSION Despite the call among survivorship experts for risk stratification, few published models are useful for risk-stratifying prevention, early detection or management of late effects. Few models address serious, modifiable late effects, limiting their utility. Cancer survivors would benefit from models focused on long-term, modifiable and serious late effects to inform the management of survivorship care.
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Affiliation(s)
- Talya Salz
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States.
| | - Shrujal S Baxi
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | | | - Erin E Onstad
- Harvard School of Public Health, Boston, MA, United States
| | | | | | | | - Karyn A Goodman
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | | | | | | | | | - Andrew J Vickers
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
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Effect of aging and long-term erectile function after iodine-125 prostate brachytherapy. Brachytherapy 2015; 14:334-41. [PMID: 25684438 DOI: 10.1016/j.brachy.2015.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/04/2015] [Accepted: 01/06/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate long-term erectile function (EF) in men treated with iodine-125 prostate brachytherapy (PB) and to determine factors predictive for erectile dysfunction (ED), including natural decline because of aging. METHODS Two thousand nine hundred twenty-nine patients (implanted July 1989-June 2012) with baseline EF and greater than 10-month followup (FU) are included. About 78.9% had full and 7.9% had partial EF at baseline. EF was assessed on a physician-reported three-point scale. Poisson regression with generalized estimating equations was used to assess predictors of ED and Kaplan-Meier curves time to ED. The effect of aging was calculated from the declining rate of baseline EF seen in sequential 5-year age cohorts and from the Massachusetts Male Aging Study. RESULTS The median age was 66 years and median FU 3.5 years (maximum 14 years). About 1142 patients had more than 5 years of FU, and 43% had received 6 months of androgen deprivation therapy (ADT). Significant drop in EF was seen at 6 weeks after PB, with gradual decline thereafter. EF preservation at 5 years for age younger than 55, 56-59, 60-64, 65-69, and 70 year and older was 82%, 73%, 58%, 39%, and 23%, respectively. Comparisons of the 5-year age-related and treatment-related EF decline show that 50% of the long-term EF decline is related to aging. On univariate and multivariate analyses, age at implant, length of FU, hypertension, diabetes, and use of ADT (all p < 0.01) were significant predictors of ED. CONCLUSION More than 80% of young men have EF preserved 5 years after PB. Age, ADT, history of hypertension, and the natural decline in EF have negative impact on long-term EF after PB.
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134
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Kim JH, Lee SW. Current status of penile rehabilitation after radical prostatectomy. Korean J Urol 2015; 56:99-108. [PMID: 25685296 PMCID: PMC4325125 DOI: 10.4111/kju.2015.56.2.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/12/2014] [Indexed: 12/23/2022] Open
Abstract
Although disease-free survival remains the primary goal of prostate cancer treatment, erectile dysfunction (ED) remains a common complication that affects the quality of life. Even though several preventive and therapeutic strategies are available for ED after radical prostatectomy (RP), no specific recommendations have been made on the optimal rehabilitation or treatment strategy. Several treatment options are available, including phosphodiesterase-5 inhibitors, vacuum erection devices, intracavernosal or intraurethral prostaglandin injections, and penile prostheses. Urologists must consider more effective ways to establish optimal treatments for ED after RP. ED is an important issue among patients with prostate cancer, and many patients hope for early ED recovery after surgery. This review highlights the currently available treatment options for ED after RP and discusses the limitations of each.
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Affiliation(s)
- Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung Wook Lee
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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135
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Quality of life after primary treatment for localized prostate cancer: long-term considerations. Eur Urol 2014; 68:609-10. [PMID: 25533419 DOI: 10.1016/j.eururo.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/01/2014] [Indexed: 11/23/2022]
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136
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Bryant C, Hoppe BS, Mendenhall NP, Henderson RH, Nichols RC, Morris CG, Williams CR, Harris SE, Su Z, Li Z, Mendenhall WM. Testosterone Replacement Therapy in Men with Prostate Cancer after Proton Therapy. Int J Part Ther 2014. [DOI: 10.14338/ijpt-14-00004.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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137
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Delage F, Perrouin-Verbe MA, Le Fur E, Papin G, Thoulouzan M, Malhaire JP, Pradier O, Fournier G, Valéri A. [Erectile dysfunction evaluation after brachytherapy for low risk prostate adenocarcinoma: prospective study of patients with a baseline IIEF5>16]. Prog Urol 2014; 25:68-74. [PMID: 25497176 DOI: 10.1016/j.purol.2014.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 09/12/2014] [Accepted: 11/03/2014] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate erectile function (EF) prospectively from 1 to 2 years post-brachytherapy in patients with a baseline IIEF5 score>16. METHODS Between 2007 and 2012, 179 patients underwent an exclusive brachytherapy for localised low risk prostate adenocarcinoma. Neo-adjuvant hormotherapy (15.6%) and post-brachytherapy intake phosphodiesterase inhibitors (PDE5i) were not considered as exclusion criteria. EF was evaluated via a scoring questionnaire IIEF5 before the surgical implantation, at month 12 and 24 post-operation. Only patients with an initial IIEF5 score>16 were included. RESULTS Of the 179 patients, 102 (57%) had a baseline IIEF5>16. At 12 months, 51.1% maintained an IIEF5>16 and 24.5% had a mild to moderate erectile dysfunction (ED), so that a total of 75.6% with IIEF5≥12. About 18% of patients had used PDE5i. At 24 months, 53.2% had an IIEF5>16 and 80.6% had an IIEF5≥12. Severe ED was reported in only 14.5% of the patients. The mean IIEF5 was 16.2 with an average decline of 5 points from the initial stage. All patients who were treated with PDE5i (27%) could have sexual intercourse. EF at baseline was reported as the only predictive factor of ED in multivariate analysis, 70% of patient without ED initially, had an IIEF5>16 at 1 and 2 years. CONCLUSION Severe ED was quite rare (14%) during the first 2 years post-brachytherapy and more than half of patients maintained an IIEF5>16. The main predictive factor was the erectile function at baseline. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F Delage
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - M-A Perrouin-Verbe
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - E Le Fur
- Service de radiothérapie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - G Papin
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - M Thoulouzan
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - J-P Malhaire
- Service de radiothérapie, CHU de Brest, 29200 Brest, France.
| | - O Pradier
- Service de radiothérapie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France.
| | - G Fournier
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France; CeRePP, hôpital Pitié-Salpétrière, 75013 Paris, France.
| | - A Valéri
- Service d'urologie, CHU de Brest, 29200 Brest, France; Faculté de médecine et des sciences de la santé, université de Brest, 29200 Brest, France; Université européenne de Bretagne, 29200 Brest, France; CeRePP, hôpital Pitié-Salpétrière, 75013 Paris, France.
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138
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Martin NE, D'Amico AV. Progress and controversies: Radiation therapy for prostate cancer. CA Cancer J Clin 2014; 64:389-407. [PMID: 25234700 DOI: 10.3322/caac.21250] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/14/2014] [Accepted: 08/15/2014] [Indexed: 12/14/2022] Open
Abstract
Radiation therapy remains a standard treatment option for men with localized prostate cancer. Alone or in combination with androgen-deprivation therapy, it represents a curative treatment and has been shown to prolong survival in selected populations. In this article, the authors review recent advances in prostate radiation-treatment techniques, photon versus proton radiation, modification of treatment fractionation, and brachytherapy-all focusing on disease control and the impact on morbidity. Also discussed are refinements in the risk stratification of men with prostate cancer and how these are better for matching patients to appropriate treatment, particularly around combined androgen-deprivation therapy. Many of these advances have cost and treatment burden implications, which have significant repercussions given the prevalence of prostate cancer. The discussion includes approaches to improve value and future directions for research.
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Affiliation(s)
- Neil E Martin
- Assistant Professor, Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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139
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Yamazaki H, Nakamura S, Nishimura T, Yoshida K, Yoshioka Y, Koizumi M, Ogawa K. Transitioning from conventional radiotherapy to intensity-modulated radiotherapy for localized prostate cancer: changing focus from rectal bleeding to detailed quality of life analysis. JOURNAL OF RADIATION RESEARCH 2014; 55:1033-1047. [PMID: 25204643 PMCID: PMC4229926 DOI: 10.1093/jrr/rru061] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/27/2014] [Accepted: 06/09/2014] [Indexed: 06/02/2023]
Abstract
With the advent of modern radiation techniques, we have been able to deliver a higher prescribed radiotherapy dose for localized prostate cancer without severe adverse reactions. We reviewed and analyzed the change of toxicity profiles of external beam radiation therapy (EBRT) from the literature. Late rectal bleeding is the main adverse effect, and an incidence of >20% of Grade ≥2 adverse events was reported for 2D conventional radiotherapy of up to 70 Gy. 3D conformal radiation therapy (3D-CRT) was found to reduce the incidence to ∼10%. Furthermore, intensity-modulated radiation therapy (IMRT) reduced it further to a few percentage points. However, simultaneously, urological toxicities were enhanced by dose escalation using highly precise external radiotherapy. We should pay more attention to detailed quality of life (QOL) analysis, not only with respect to rectal bleeding but also other specific symptoms (such as urinary incontinence and impotence), for two reasons: (i) because of the increasing number of patients aged >80 years, and (ii) because of improved survival with elevated doses of radiotherapy and/or hormonal therapy; age is an important prognostic factor not only for prostate-specific antigen (PSA) control but also for adverse reactions. Those factors shift the main focus of treatment purpose from survival and avoidance of PSA failure to maintaining good QOL, particularly in older patients. In conclusion, the focus of toxicity analysis after radiotherapy for prostate cancer patients is changing from rectal bleeding to total elaborate quality of life assessment.
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Affiliation(s)
- Hideya Yamazaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Satoaki Nakamura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Takuya Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Ken Yoshida
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki-City, Osaka, 569-8686, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871 Osaka, Japan
| | - Masahiko Koizumi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871 Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, 565-0871 Osaka, Japan
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Tar M, Cabrales P, Navati M, Adler B, Nacharaju P, Friedman AJ, Friedman J, Davies KP. Topically applied NO-releasing nanoparticles can increase intracorporal pressure and elicit spontaneous erections in a rat model of radical prostatectomy. J Sex Med 2014; 11:2903-14. [PMID: 25302850 DOI: 10.1111/jsm.12705] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Patients undergoing radical prostatectomy (RP) suffer from erectile dysfunction (ED) refractory to phosphodiesterase 5 inhibitors, which act downstream of cavernous nerve (CN)-mediated release of nitric oxide (NO). Direct delivery of NO to the penis could potentially circumvent this limitation. AIM This study aimed to determine if topically applied NO-releasing nanoparticles (NO-NPs) could elicit erections in a rat model of RP through increased blood flow. METHODS Twenty-six Sprague Dawley rats underwent bilateral transection of the CN. One week later, NO-NPs were applied topically to the penile shaft in dimethylsulfoxide (DMSO) gel (10 animals) or coconut oil (6 animals). Control animals were treated with empty NPs. Erectile function was determined through the intracorporal pressure/blood pressure ratio (ICP/BP). The effect of the NO-NPs on blood flow was determined using a hamster dorsal window chamber. MAIN OUTCOME MEASURES Animals were investigated for spontaneous erections, onset and duration of erectile response, and basal ICP/BP ratio. Microcirculatory blood flow was determined through measurements of arteriolar and venular diameter and red blood cell velocity. RESULTS Eight of 10 animals treated with NO-NPs suspended in DMSO gel had significant increases in basal ICP/BP, and 6 out of these 10 animals demonstrated spontaneous erections of approximately 1 minute in duration. Time to onset of spontaneous erections ranged from 5 to 37 minutes, and they occurred for at least 45 minutes. Similar results were observed with NO-NPs applied in coconut oil. No erectile response was observed in control animal models treated with empty NPs. The hamster dorsal window chamber experiment demonstrated that NO-NPs applied as a suspension in coconut oil caused a significant increase in the microcirculatory blood flow, sustained over 90 minutes. CONCLUSIONS Topically applied NO-NPs induced spontaneous erections and increased basal ICP in an animal model of RP. These effects are most likely due to increased microcirculatory blood flow. These characteristics suggest that NO-NPs would be useful in penile rehabilitation of patients following RP.
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Affiliation(s)
- Moses Tar
- Department of Urology, Albert Einstein College of Medicine, New York, NY, USA
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Pugh TJ, Mahmood U, Swanson DA, Munsell MF, Wang R, Kudchadker RJ, Bruno TL, Frank SJ. Sexual potency preservation and quality of life after prostate brachytherapy and low-dose tadalafil. Brachytherapy 2014; 14:160-5. [PMID: 25255712 DOI: 10.1016/j.brachy.2014.08.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/01/2014] [Accepted: 08/04/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To prospectively determine sexual function, bother, and potency preservation in men treated with prostate brachytherapy and twice-weekly tadalafil. METHODS AND MATERIALS From 2005 to 2011, men treated with low-dose-rate prostate brachytherapy were treated on a prospective registration study. All patients were prescribed tadalafil 10mg twice weekly. The expanded prostate cancer index composite questionnaire was administered before treatment and at each followup. A subgroup analysis of men with sexual potency at baseline was performed. RESULTS A total of 237 men were analyzed. Median age was 64 years (range, 44-86). Median followup was 24.8 months (range, 1-60). At baseline, 175 men (74%) reported erections firm enough for sexual activity and 148 (62%) were potent (erections firm enough for intercourse). Statistically significant changes in sexual function/bother were appreciated from baseline throughout the analysis period, although absolute changes were relatively small and did not meet criteria for clinical significance. At 24-months followup, 72% reported erections firm enough for sexual activity and 56% were potent. Of men with potency at baseline, 89% had erections firm enough for sexual activity and 76% remained potent 24 months after treatment. CONCLUSIONS Peri-procedural tadalafil and prostate brachytherapy resulted in high rates of sexual potency preservation and no clinically significant effect on sexual quality of life.
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Affiliation(s)
- Thomas J Pugh
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
| | - Usama Mahmood
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - David A Swanson
- Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Run Wang
- Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Rajat J Kudchadker
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Teresa L Bruno
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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Terrier JE, Ferretti L, Journel NM, Ben-Naoum K, Graziana JP, Huyghe E, Marcelli F, Methorst C, Montaigne O, Savareux L, Faix A. [Should we recommend an erectile rehabilitation after radical prostatectomy? Systematic review of the literature by the Sexual Medicine Committee of the French Urology Association]. Prog Urol 2014; 24:1043-9. [PMID: 25218439 DOI: 10.1016/j.purol.2014.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 07/02/2014] [Accepted: 07/17/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radical prostatectomy has evolved considerably during the last 20 years, with one hand, a thorough knowledge of the anatomy of the prostate, and secondly, the introduction of new conservation techniques of neurovascular bundles. Despite this progress, the rate of post-prostatectomy erectile dysfunction varies between 30 and 90% depending on the series and this element impacts the quality of life after radical prostatectomy. The objective of this work was to conduct a review of the literature in order to evaluate the various protocols of post-radical prostatectomy erectile rehabilitation. PATIENTS AND METHODS A systematic review of the literature from the basic PubMed search was performed using the following keywords. Therapy erectile dysfunction, radical prostatectomy, penile rehabilitation, phosphodiesterase 5 inhibitor, intracavernous injection. RESULTS The critical analysis of selected studies highlights the lack of standard protocol that established erectile rehabilitation early after radical prostatectomy. These studies have shown that early treatment, injections or intracavernous PDE5 inhibitors improved recovery of erections as recommended by the French Association of Urology. CONCLUSION Management of disorders of post-radical prostatectomy sexuality is essential, it must be organized in a well-established protocol combining pharmacological and therapeutic education assistances delivered by practitioners or nurses. It would need to develop in a clinical trial a standard protocol.
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Affiliation(s)
- J-E Terrier
- Service d'urologie-andrologie, université Jean-Monnet, CHU de Saint-Étienne, 34, rue Francis-Baulier, 42023 Saint-Étienne cedex 2, France.
| | - L Ferretti
- Service d'urologie-andrologie, CHU de Bordeaux, 33000 Bordeaux, France
| | - N Morel Journel
- Service d'urologie-andrologie, CHU Lyon sud, hospices civiles de Lyon, 69495 Lyon, France
| | - K Ben-Naoum
- Service d'urologie-andrologie, CHU de Nîmes, 30029 Nîmes, France
| | - J-P Graziana
- Service d'urologie-andrologie, clinique mutualiste de la Porte de l'Orient, 56100 L'Orient, France
| | - E Huyghe
- Service d'urologie-andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - F Marcelli
- Service d'urologie-andrologie, CHU de Lille, 59000 Lille, France
| | - C Methorst
- Service d'urologie-andrologie, hôpital Foch, 92151 Suresnes, France
| | - O Montaigne
- Service d'urologie-andrologie, CHU de Lille, 59000 Lille, France
| | - L Savareux
- Service d'urologie-andrologie, clinique de la Chataigneraie, 63110 Clermont-Ferrand, France
| | - A Faix
- Service d'urologie-andrologie, clinique Beausoleil, 34070 Montpellier, France
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Controversies associated with the evaluation of elderly men with localized prostate cancer when considering radical prostatectomy. Int J Clin Oncol 2014; 19:793-9. [DOI: 10.1007/s10147-014-0738-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/03/2014] [Indexed: 12/27/2022]
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Predictive factors for return of erectile function in robotic radical prostatectomy: case series from a single centre. Int J Impot Res 2014; 27:29-32. [DOI: 10.1038/ijir.2014.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/23/2014] [Accepted: 06/06/2014] [Indexed: 11/08/2022]
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145
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146
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Skolarus TA, Hawley ST. Prostate cancer survivorship care in the Veterans Health Administration. Fed Pract 2014; 31:10-17. [PMID: 30369784 PMCID: PMC6201257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The burden of prostate cancer among Veterans is substantial with over 200,000 survivors and 12,000 new diagnoses annually. Most men live with rather than die from this common and expensive disease making prostate cancer survivorship care especially important. In addition, the symptom burden after prostate cancer treatment can be substantial, last well into survivorship and lead to reduced quality of life and greater use of services. For these reasons, it is increasingly recognized that cancer survivorship care is similar to chronic disease management in requiring a combination of primary care providers and cancer specialists to deliver care over long periods of time. Because of its leadership in chronic disease care and the proportion of older men served, the Veterans Health Administration (VHA) is well positioned to become one of the national leaders in prostate cancer survivorship care. However, best practices and portfolios of quality indicators for prostate cancer survivorship care remain underdeveloped. More broadly, there is a limited consensus about who (primary care providers or prostate cancer specialists - urologists, radiation and medical oncologists) has primary responsibility for prostate cancer surveillance, and who manages the often substantial and lingering treatment-related side effects. Unclear roles and regional variation in the VHA cancer specialist workforce also complicate delivery of quality survivorship care. Ultimately, the design and implementation of tools to facilitate the delivery of optimal cancer survivorship care in VHA rests upon understanding how responsibility for survivorship care is managed and the barriers to quality survivorship care. Due to the expanding population of Veteran prostate cancer survivors, improving their quality of survivorship care through effective use of the VHA's provider workforce and latest telemedicine initiatives has potential to transform the national efficiency and effectiveness of cancer specialty care delivery.
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Affiliation(s)
- Ted A. Skolarus
- Dow Division of Health Services Research, Department of Urology, University of Michigan
- Division of Oncology, Department of Urology, University of Michigan
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan
| | - Sarah T. Hawley
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan
- Department of Internal Medicine, University of Michigan
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147
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Plym A, Folkvaljon Y, Garmo H, Holmberg L, Johansson E, Fransson P, Stattin P, Lambe M. Drug Prescription for Erectile Dysfunction Before and After Diagnosis of Localized Prostate Cancer. J Sex Med 2014; 11:2100-8. [DOI: 10.1111/jsm.12586] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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148
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Kacker R, Morgentaler A, Traish A. Medical Hypothesis: Loss of the Endocrine Function of the Prostate Is Important to the Pathophysiology of Postprostatectomy Erectile Dysfunction. J Sex Med 2014; 11:1898-902. [DOI: 10.1111/jsm.12574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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149
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Ong WL, Hindson BR, Beaufort C, Pharoah P, Millar JL. Long-term erectile function following permanent seed brachytherapy treatment for localized prostate cancer. Radiother Oncol 2014; 112:72-6. [PMID: 25086852 DOI: 10.1016/j.radonc.2014.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 04/21/2014] [Accepted: 04/25/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Erectile function (EF) is commonly affected following prostate cancer treatment. We aim to evaluate the long-term EF following seed brachytherapy (BT) treatment. MATERIALS AND METHODS The study consisted of 366 patients treated with BT at our institution, who completed the IIEF-5 questionnaire and reported no or mild erectile dysfunction (ED) pre-BT. The probability of EF preservation post-BT was estimated using the Kaplan-Meier methods. The difference in EF preservation by patient-, tumour- and treatment-related factors was assessed using the log-rank test. Multivariate Cox regression was used to estimate the effect of each factor on EF preservation. RESULTS Of the 366 patients, 277 (76%) reported normal EF, and 89 (24%) reported mild ED. The patients were followed-up for a median of 41 months (range: 3-124), and the 5-year actuarial rate of EF preservation was 59%. Age at BT seed implant, presence of medical comorbidities, Gleason score and the biologically effective dose (BED) are associated with EF preservation (P < 0.005). The association for these four factors remains statistically significant in multivariate analysis, with Gleason score having the strongest effect (HR = 3.7; 95% CI = 2.6-5.4). CONCLUSION The 5-year actuarial rate of EF preservation post-BT in our cohort is 59%, and is influenced by multiple factors.
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Affiliation(s)
- Wee Loon Ong
- William Buckland Radiotherapy Centre, Alfred Health, Melbourne, Australia; Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Benjamin R Hindson
- William Buckland Radiotherapy Centre, Alfred Health, Melbourne, Australia
| | - Catherine Beaufort
- William Buckland Radiotherapy Centre, Alfred Health, Melbourne, Australia
| | - Paul Pharoah
- Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Jeremy L Millar
- William Buckland Radiotherapy Centre, Alfred Health, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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150
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Haskins AE, Han PKJ, Lucas FL, Bristol I, Hansen M. Development of clinical models for predicting erectile function after localized prostate cancer treatment. Int J Urol 2014; 21:1227-33. [DOI: 10.1111/iju.12566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 06/15/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Amy E Haskins
- Center for Outcomes Research and Evaluation; Maine Medical Center; Portland Maine USA
| | - Paul KJ Han
- Center for Outcomes Research and Evaluation; Maine Medical Center; Portland Maine USA
| | - Frances L Lucas
- Center for Outcomes Research and Evaluation; Maine Medical Center; Portland Maine USA
| | - Ian Bristol
- Department of Radiation Oncology; Maine Medical Center; Portland Maine USA
| | - Moritz Hansen
- Division of Urology; Maine Medical Center; Portland Maine USA
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