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Chardon A, Udrescu C, Beneux A, Ruffion A, Horn S, Lapierre A, Chapet O. Erectile function preservation after radiotherapy using a dose-optimization approach on sexual structures for localized prostate cancer. Cancer Radiother 2024; 28:182-187. [PMID: 38599939 DOI: 10.1016/j.canrad.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/05/2023] [Accepted: 08/09/2023] [Indexed: 04/12/2024]
Abstract
PURPOSE Erectile function preservation is an important quality of life factor in patients treated for prostate cancer. A dose-optimization approach on sexual structures was developed and evaluated to limit erectile dysfunction after radiotherapy. MATERIALS AND METHODS Twenty-three men with localized prostate cancer and no erectile dysfunction were enrolled in the study. All patients received a prescription dose between 76 and 78Gy. Computed tomography/magnetic resonance image registration was used to delineate the prostatic volume and the sexual structures: internal pudendal arteries (IPA), penile bulb and corpus cavernosum. Erectile function was evaluated using the 5-items International Index of Erectile Function (IIEF-5) score every 6 months during the 2 years after radiotherapy and once a year afterwards. No erectile dysfunction, mild erectile dysfunction and severe erectile dysfunction were defined if the IIEF-5 scores were 20-25, 17-19 and < 17, respectively. RESULTS The mean follow-up was 4.5 years. The mean age of the patients was 66.3 years. At 2 years, 67% of the patients had no erectile dysfunction, 11% had mild erectile dysfunction and 22% had severe erectile dysfunction. No significant difference was found between the patients with and without erectile dysfunction (IIEF-5≥20 and IIEF-5<20, respectively) for any of the parameters: dosimetric values (internal pudendal arteries, penile bulb, corpus cavernosum), age, comorbidity and smoking status. The biochemical-relapse free survival was 100% at 2 years. CONCLUSION This approach with dose-optimization on sexual structures for localized prostate cancer found excellent results on erectile function preservation after radiotherapy, with 78% of the patients with no or mild erectile dysfunction at 2 years.
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Affiliation(s)
- A Chardon
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France
| | - C Udrescu
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France
| | - A Beneux
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - A Ruffion
- Université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France; Department of Urology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - S Horn
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - A Lapierre
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France
| | - O Chapet
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France.
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Gesztesi L, Kocsis ZS, Jorgo K, Fröhlich G, Polgár C, Ágoston P. Alterations of Sexual and Erectile Functions after Brachytherapy for Prostate Cancer Based on Patient-Reported Questionnaires. Prostate Cancer 2024; 2024:5729185. [PMID: 38312318 PMCID: PMC10834089 DOI: 10.1155/2024/5729185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/16/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
The aim of the study was to compare the side effects of high-dose-rate brachytherapy (HDRBT) and low-dose-rate brachytherapy (LDRBT), with a particular focus on the effects on sexual functions and sexual well-being (PROMOBRA study, NCT02258087). Localized low-risk and low-intermediate-risk prostate cancer patients were treated with mono LDR (N = 123, 145 Gy dose) or mono HDR brachytherapy (N = 117, 19/21 Gy). Prior to the treatment and during follow-up (at 3, 6, 9, 12, 18, and 24 months after treatment, and then annually after two years), patients completed patient-reported outcome measurement (PROM) questionnaires EORTC QLQ-PR-25, International Index of Erectile Function (IIEF), and IIEF-5 (SHIM). We compared the patients in different group breakdowns (HDR vs. LDR, hormone naïve and hormone-receiving HDR vs. LDR, hormone naïve and hormone-receiving patients in general, and 19 Gy HDR vs. 21 Gy HDR). In the hormone-naive LDR group, erectile function, orgasm function, sexual desire, satisfaction with intercourse, and overall satisfaction functions significantly decreased compared to baseline throughout the whole follow-up period. However, there were significant decreases in function at a maximum of three time points after HDR therapy without hormone therapy. In hormone-receiving patients, the orgasm function was significantly better in the HDR group at multiple time points compared to the baseline, and sexual desire improved at four time points. According to our results, both LDRBT and HDRBT can be safely administered to patients with localized prostate cancer. In hormone-naive patients, the HDR group showed only recovering decreases in sexual functions, while the LDR group showed a lasting decline in multiple areas. Thus, HDR appears to be more advantageous to hormone-naive patients.
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Affiliation(s)
- László Gesztesi
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary
| | - Zsuzsa S. Kocsis
- National Institute of Oncology, Centre of Radiotherapy, Department of Radiobiology and Diagnostic Onco-Cytogenetics and National Tumorbiology Laboratory, Budapest, Hungary
| | - Kliton Jorgo
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary
- Semmelweis University, Department of Oncology, Budapest, Hungary
| | - Georgina Fröhlich
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary
| | - Csaba Polgár
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary
- Semmelweis University, Department of Oncology, Budapest, Hungary
| | - Péter Ágoston
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary
- Semmelweis University, Department of Oncology, Budapest, Hungary
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Kissel M, Créhange G, Graff P. Stereotactic Radiation Therapy versus Brachytherapy: Relative Strengths of Two Highly Efficient Options for the Treatment of Localized Prostate Cancer. Cancers (Basel) 2022; 14:2226. [PMID: 35565355 PMCID: PMC9105931 DOI: 10.3390/cancers14092226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) has become a valid option for the treatment of low- and intermediate-risk prostate cancer. In randomized trials, it was found not inferior to conventionally fractionated external beam radiation therapy (EBRT). It also compares favorably to brachytherapy (BT) even if level 1 evidence is lacking. However, BT remains a strong competitor, especially for young patients, as series with 10-15 years of median follow-up have proven its efficacy over time. SBRT will thus have to confirm its effectiveness over the long-term as well. SBRT has the advantage over BT of less acute urinary toxicity and, more hypothetically, less sexual impairment. Data are limited regarding SBRT for high-risk disease while BT, as a boost after EBRT, has demonstrated superiority against EBRT alone in randomized trials. However, patients should be informed of significant urinary toxicity. SBRT is under investigation in strategies of treatment intensification such as combination of EBRT plus SBRT boost or focal dose escalation to the tumor site within the prostate. Our goal was to examine respective levels of evidence of SBRT and BT for the treatment of localized prostate cancer in terms of oncologic outcomes, toxicity and quality of life, and to discuss strategies of treatment intensification.
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Affiliation(s)
| | | | - Pierre Graff
- Department of Radiation Oncology, Institut Curie, 26 Rue d’Ulm, 75005 Paris, France; (M.K.); (G.C.)
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Anderson E, Smyth LML, O'Sullivan R, Ryan A, Lawrentschuk N, Grummet J, See AW. Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution. Transl Androl Urol 2021; 10:3591-3603. [PMID: 34733655 PMCID: PMC8511546 DOI: 10.21037/tau-21-508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022] Open
Abstract
Background Focal treatment for prostate cancer (PCa) is a hybrid approach combining ablative treatment of the involved prostate gland and continued active surveillance (AS) of the unaffected gland. Low dose-rate (LDR) brachytherapy can be used as a lesion-targeted focal therapy, however, further studies are required to support its use. The aim of this study is to evaluate the dosimetry, toxicity and oncological outcomes of men receiving lesion-targeted focal LDR brachytherapy for low to intermediate risk PCa. Methods This is a retrospective cohort study of 26 men with unifocal, low to intermediate grade PCa diagnosed on a combination of multiparametric-magnetic resonance imaging (mp-MRI) and targeted plus template transperineal (TP) biopsy, who received focal LDR brachytherapy at a single institution. Brachytherapy involved a single monotherapy implant using iodine-125 seeds to deliver a prescribed dose of 145 Gy to the index lesion. Results The mean focal planning target volume (F-PTV) as a percentage of the prostate volume was 24.5%. The percentage of the focal gross tumour volume (F-GTV) receiving 100% of the prescription dose was 100% for 12 patients and ≥98% for 18 patients. The median follow-up for toxicity and biochemical control outcomes was 23.1 [interquartile range (IQR) 19.1–31.3] and 24.2 (IQR 17.9–30.0) months, respectively. Grade 2 urinary and erectile toxicities were reported by 29.2% and 45.8% of patients, respectively, with resolution of urinary symptoms to baseline by last follow-up. There were no grade ≥3 urinary or erectile toxicities or grade ≥2 rectal toxicity. All 21 patients who underwent a repeat mp-MRI and TP biopsy at 12–24 months post-treatment were negative for clinically significant disease and 25 (96.2%) patients were free from biochemical failure (FFBF). Conclusions Focal LDR brachytherapy is associated with a favourable toxicity profile and a high rate of control of significant PCa at 12–18 months post-treatment. We have commenced the LIBERATE prospective registry in focal LDR brachytherapy based on the highly encouraging outcomes of this initial experience.
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Affiliation(s)
- Elliot Anderson
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | | | - Richard O'Sullivan
- Healthcare Imaging Services, Richmond, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Andrew Ryan
- TissuPath Specialist Pathology Services, Mount Waverley, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia.,EJ Whitten Centre for Prostate Cancer Research, Epworth Healthcare, Melbourne, Australia
| | - Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.,Epworth Healthcare, Richmond, Australia
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Nakai Y, Tanaka N, Asakawa I, Miyake M, Anai S, Yamaki K, Hasegawa M, Fujimoto K. Erectile dysfunction and sexual quality of life in patients who underwent low-dose-rate brachytherapy alone for prostate cancer. Andrologia 2021; 54:e14288. [PMID: 34693547 DOI: 10.1111/and.14288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/12/2021] [Indexed: 12/01/2022] Open
Abstract
This study evaluated erectile function and sexual quality of life (QoL), and predictive factors for erectile dysfunction (ED) and the deterioration of sexual QoL in 70 patients who underwent low-dose-rate brachytherapy (LDR-BT) alone for prostate cancer without androgen deprivation therapy. Erectile function and sexual QoL were evaluated before and 1, 3, 6, 12, 24, 36, 48 and 60 months after LDR-BT. Binary logistic regression analysis was used to determine whether age, prostate volume, hypertension, diabetes, Brinkman's index, testosterone, baseline Sexual Health Inventory for Men (SHIM) score and post-implant dosimetry parameters could predict ED and deterioration of sexual QoL at 24 and 60 months after LDR-BT. After 24 and 60 months, ED was noted in 39 of 70 patients and 42 of 64 patients respectively. Furthermore, sexual QoL worsened in 42 of 70 and 43 of 64 patients respectively. Baseline SHIM score was identified as a significant predictor of ED (24 months: odds ratio [OR]: 0.83, p = 0.02; 60 months: OR: 0.83, p = 0.03) and the deterioration of sexual QoL (24 months: OR: 0.84, p = 0.03). LDR-BT for prostate cancer promoted decreased erectile function and sexual QoL, with high preimplant potency being a significant predictor of ED and the deterioration of sexual QoL.
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Affiliation(s)
- Yasushi Nakai
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Nara, Japan
| | - Kaori Yamaki
- Department of Radiation Oncology, Nara Medical University, Nara, Japan
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Helou J, Charas T. Acute and late side-effects after low dose-rate brachytherapy for prostate cancer; incidence, management and technical considerations. Brachytherapy 2021; 20:956-965. [PMID: 33972182 DOI: 10.1016/j.brachy.2021.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To review common reported side effects and complications after primary LDR-BT (monotherapy) and discuss some of the technical aspects that could impact the treatment outcomes. METHODS AND MATERIALS A literature search was undertaken using medical subject headings (MeSH) complemented by the authors' personal and institutional expertise. RESULTS The reported incidence of acute and late grade 2 or above urinary, bowel and sexual side effects is very variable across the literature. The learning curve and the implant quality have a clear impact on the toxicity outcomes. Being aware of some of the technical challenges encountered during the procedure and ways to mitigate them could decrease the incidence of side effects. Careful planning of seed placement and seed deposition allow sparing of the organs at risk and a lower incidence of urinary and gastro-intestinal toxicity. CONCLUSIONS Low dose-rate brachytherapy remains a standard monotherapy treatment in the setting of favorable-risk prostate cancer. High disease control and low long-term toxicities are achievable in expert hands with a good technique.
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Affiliation(s)
- Joelle Helou
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | - Tomer Charas
- Radiotherapy Unit, Oncology Division, Rambam Health Care Campus, Haifa, Israel
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Risk of erectile dysfunction after modern radiotherapy for intact prostate cancer. Prostate Cancer Prostatic Dis 2020; 24:128-134. [PMID: 32647352 DOI: 10.1038/s41391-020-0247-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/05/2020] [Accepted: 06/30/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is a prevalent side effect of prostate cancer treatment. We hypothesized that the previously reported rates of ED may have improved with the advent of modern technology. The purpose of this project was to evaluate modern external beam radiotherapy and brachytherapy techniques to determine the incidence of radiotherapy (RT) induced ED. METHODS A systematic review of the literature published between January 2002 and December 2018 was performed to obtain patient reported rates of ED after definitive external beam radiotherapy, ultrafractionated stereotactic radiotherapy, and brachytherapy (BT) to the prostate in men who were potent prior to RT. Univariate and multivariate analyses of radiation dose, treatment strategy, and length of follow-up were analyzed to ascertain their relationship with RT-induced ED. RESULTS Of 890 articles reviewed, 24 met inclusion criteria, providing data from 2714 patients. Diminished erectile function status post RT was common and similar across all studies. The median increase in men reporting ED was 17%, 26%, 23%, and 23%, 3DCRT, IMRT, low dose rate BT, and SBRT, respectively, at 2-year median follow-up. CONCLUSION ED is a common side effect of RT. Risk of post-RT ED is similar for both LDR brachytherapy and external beam RT with advanced prostate targeting and penile-bulb sparing techniques utilized in modern RT techniques.
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Nukala V, Incrocci L, Hunt AA, Ballas L, Koontz BF. Challenges in Reporting the Effect of Radiotherapy on Erectile Function. J Sex Med 2020; 17:1053-1059. [PMID: 32312661 DOI: 10.1016/j.jsxm.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is the most common side effect of prostate radiotherapy (RT), but reported rates over time and across modalities have varied widely. AIM To evaluate the published literature between 2002 and 2018 for high quality data utilizing prospectively gathered patient-reported ED, and to summarize the challenges in reporting of RT-induced ED (RIED). METHODS A PubMed search and literature review was performed to identify articles describing rates of ED before and after definitive external beam RT or brachytherapy without androgen deprivation. OUTCOMES Patient-reported ED, patient and treatment variables, and study follow-up constituted the main outcomes of this study. RESULTS 24 articles were identified, reporting RIED rates between 17% and 90%. Variables contributing to this range included patient, treatment, and study characteristics known to impact ED reporting. CLINICAL IMPLICATIONS For future studies, we recommend the use of validated patient-reported questionnaires and reporting of baseline function and comorbidities, RT type and dose, and use of androgen deprivation therapy and erectile aids at the time of ED measurement. With sufficient follow-up to understand the late nature of RIED, these recommendations will improve comparison of results between studies and the applicability of results to patients undergoing pretreatment counseling regarding the risks of RIED. STRENGTHS & LIMITATIONS The literature search and formulation of results were based on a broad understanding of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the literature, but because of the focus on data reporting, a comprehensive systematic review of all RIED literature was not performed. CONCLUSION Reported rates of ED after RT vary widely due to differences in patients' baseline reported erectile function, age, comorbidities, and characteristics of the treatment delivered. The methodology of ED measurement has significant impact on the applicability and comparability of results to other studies and clinical practice. Nukala V, Incrocci L, Hunt AA, et al. Challenges in Reporting the Effect of Radiotherapy on Erectile Function. J Sex Med 2020;17:1053-1059.
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Affiliation(s)
- Varun Nukala
- Department of Neuroscience, Duke University, Durham, NC, USA
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Leslie Ballas
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA, USA
| | - Bridget F Koontz
- Department of Neuroscience, Duke University, Durham, NC, USA; Department of Radiation Oncology, Duke Cancer Institute, Durham, NC, USA.
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Bazinet A, Zorn KC, Taussky D, Delouya G, Liberman D. Favorable preservation of erectile function after prostate brachytherapy for localized prostate cancer. Brachytherapy 2019; 19:222-227. [PMID: 31837989 DOI: 10.1016/j.brachy.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE We analyzed the rate of preserved potency after prostate brachytherapy (PB) with radioactive seeds and the impact of patient comorbidities on post-PB erectile dysfunction (ED). METHODS We included 627 patients who were assessed for pre- and postimplant potency between 2005 and 2017. Assessment was based on the Common Terminology Criteria for Adverse Events Scale (CTCAEs). Logistic regression models were used to assess clinical predictors of preserved potency after PB defined as having sufficient erections for sexual activity with or without the need of oral pharmacologic assistance. Covariates included age, diabetes (DM), hypertension (HTN), dyslipidemia (DLP), coronary artery disease (CAD), International Prostate Symptom Score (IPSS), prostate volume, and Cancer of the Prostate Risk Assessments (CAPRA) score. Patients on androgen deprivation therapy or using five alpha reductase inhibitors were excluded from analyses. RESULTS Post-PB potency was assessed at an average of 6 months (n = 627), 1 year (n = 538), 2 years (=440), 4 years (n = 272), and 5 years (n = 124). At 2 and 5 years, post-PB potency was preserved in 87% and 84% of patients, respectively. When adjusting for all available covariates, advanced age, pre-PB potency, and the presence of vascular comorbidities (HTN, DM, and DLP) were all predictors of potency at 2 years after PB (all p < 0.01). When performing a sensitivity analysis for vascular comorbidities, the presence of DM had the strongest impact on ED than either HTN or DLP (p < 0.01). CONCLUSION More than 84% of patients had preserved potency 5 years after PB. Advanced age, pre-PB potency, and vascular comorbidities had a statistically significant impact on potency after PB.
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Affiliation(s)
- Amélie Bazinet
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Kevin C Zorn
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Daniel Taussky
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada; Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada.
| | - Guila Delouya
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Daniel Liberman
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
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Prospective four years of evaluation of erectile function after low-dose-rate prostate brachytherapy using baseline IIEF-5 > 16. J Contemp Brachytherapy 2019; 11:195-200. [PMID: 31435425 PMCID: PMC6701385 DOI: 10.5114/jcb.2019.85793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/30/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Prostate brachytherapy (BT) is a validated treatment for localized prostate cancer (CaP) and an attractive therapy option for patients seeking to preserve erectile function (EF). The aim of this paper is to prospectively assess EF evolution during 4 years after BT. Material and methods Between February 2007 and July 2012, 179 patients underwent an exclusive Iodine-125 BT, for low-intermediate favorable risk CaP of whom, 102 had an initial international index of erectile function 5 score (IIEF-5) > 16 and were included in the study. Of those, 12.7% received neo-adjuvant hormonotherapy (HT) to decrease the prostate volume. Post-BT intake of phosphodiesterase inhibitors (PDE5i) was not an exclusion criterion. Erectile function was prospectively assessed using a validated questionnaire IIEF-5 before treatment and annually for 4 years. Results At 1-year follow-up, 54% of patients preserved an IIEF-5 > 16 and only 8% suffered from severe ED. During the next 3 years, the results were not statistically different. The mean IIEF-5 lost 4 points during the first year, 17 vs. 21, and remained stable during the following 3 years. We did not find any significant differences in the proportion of patients treated by PDE5i (18-20%). As for patients with a normal preoperative IIEF-5 (> 21) (n = 52), 35-42% preserved a normal EF and 71-77% maintained an IIEF-5 > 16, including 13-19% of patients who needed PDE5i. Those results were stable for over 4 years. Conclusions During the first 4 years after BT, more than half of patients maintained an IIEF-5 > 16, and EF results remained stable. Severe erectile dysfunction (ED) was very rare.
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11
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Wortel RC, Incrocci L, Mulhall JP. Reporting Erectile Function Outcomes After Radiation Therapy for Prostate Cancer: Challenges in Data Interpretation. J Sex Med 2018; 14:1260-1269. [PMID: 28965787 DOI: 10.1016/j.jsxm.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 07/15/2017] [Accepted: 08/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Choice of prostate cancer treatment is frequently influenced by the expected chance of treatment-induced side effects such as erectile dysfunction (ED). However, great discrepancy in cited ED rates exists in the contemporary radiation therapy literature. AIM To analyze the reported ED rates and cause of discrepancies and explore the strengths and limitations in the literature on radiation-induced ED. METHODS We performed a PubMed literature search and reviewed the literature on ED rates associated with external-beam radiotherapy and brachytherapy from the past 10 years. Eighteen studies were eligible for inclusion and subsequently reviewed. OUTCOMES Variables required for interpretation of erectile function outcomes, including patient demographics, treatment characteristics, and sexual function outcomes. RESULTS A large variety in the reported incidence of ED was found among studies. In part, these differences resulted from large variations in (i) study populations, (ii) patient characteristics, (iii) treatment characteristics, (iv) prescription of androgen deprivation therapy, (v) means of data acquisition, (vi) definitions of ED, (vii) temporal considerations, and (viii) erectile aid use. Relevant data required for adequate appraisal of sexual function outcomes were not always reported. CLINICAL IMPLICATIONS Based on the present findings, we present general recommendations for reporting of erectile function outcomes after radiotherapy for prostate cancer. These should improve future reports. STRENGTHS AND LIMITATIONS This is the first report that presents general requirements on reporting erectile function outcomes in the setting of radiotherapy for prostate cancer. We did not conduct a formal meta-analysis because we focused on concepts of research design; this might be considered a limitation. CONCLUSION In this review, we have highlighted the strengths and deficiencies of the current literature on ED after external-beam radiotherapy and brachytherapy for prostate cancer. We have made general recommendations to achieve some degree of standardization among reports and improve clinical interpretability. Wortel RC, Incrocci L, Muhall JP. Reporting Erectile Function Outcomes After Radiation Therapy for Prostate Cancer: Challenges in Data Interpretation. J Sex Med 2017;14:1260-1269.
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Affiliation(s)
- Ruud C Wortel
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Sexual and Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - John P Mulhall
- Sexual and Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Loh-Doyle J, Patil MB, Nakhoda Z, Nassiri N, Yip W, Wayne K, Doumanian L, Boyd SD. Three-Piece Inflatable Penile Prosthesis Placement Following Pelvic Radiation: Technical Considerations and Contemporary Outcomes. J Sex Med 2018; 15:1049-1054. [PMID: 29731428 DOI: 10.1016/j.jsxm.2018.04.634] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 03/31/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Pelvic radiation is a known risk factor for the development and progression of erectile dysfunction. When medical therapy fails, the 3-piece inflatable penile prosthesis (IPP) can offer patients a definitive treatment option. Because of radiation-induced vascular changes and tissue fibrosis, a careful surgical approach is necessary to avoid intraoperative complications and attain successful outcomes. Despite its widespread use in prostate cancer treatment, there are no contemporary studies examining the effects that pelvic radiation can have on 3-piece IPP placement and device survival. AIM To present technical considerations and contemporary outcomes of placing a 3-piece IPP for refractory erectile dysfunction in patients with a history of pelvic radiation. METHODS We retrospectively reviewed 78 patients who underwent placement of a 3-piece IPP (AMS 700; Boston Scientific, Marlborough, MA, USA) after being treated with pelvic radiotherapy from 2003 through 2016. All patients had been treated with external beam and/or brachytherapy for treatment of prostate malignancy. An infrapubic approach was used in all patients, with reservoir placement in the space of Retzius or in the lateral retroperitoneal space. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection and mechanical failure were examined and statistical analysis was performed. OUTCOMES Rates of device infection, revision surgery, and reservoir complications. RESULTS No intraoperative complications were observed. After a mean follow-up of 49.0 months (6.6-116.8), 2 patients developed an infection of their prosthesis that required explantation. These patients underwent successful IPP removal and immediate reimplantation. 11 patients (14.1%) required revision surgery (pump replacement, n = 4; pump relocation, n = 2; cylinder replacement, n = 4; reservoir replacement owing to leak, n = 1). No reservoir-related complications such as herniation or erosion into adjacent structures were observed. CLINICAL IMPLICATIONS The 3-piece IPP can be placed safely in a broad range of patients treated with pelvic radiotherapy. STRENGTHS AND LIMITATIONS This study describes contemporary long-term outcomes of the IPP in patients treated with pelvic radiation and includes patients with prior pelvic surgery and artificial urinary sphincter, which are commonly encountered in practice. It is limited by its single-center experience and lacks a comparison group of patients. Objective patient satisfaction data were not available for inclusion. CONCLUSIONS The 3-piece IPP can be placed successfully in patients with a history of pelvic radiation without a significant increase in infectious complications, reservoir erosion, or mechanical failure compared with the global literature. Loh-Doyle J, Patil MB, Nakhoda Z, et al. Three-Piece Inflatable Penile Prosthesis Placement Following Pelvic Radiation: Technical Considerations and Contemporary Outcomes. J Sex Med 2018;15:1049-1054.
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Affiliation(s)
- Jeffrey Loh-Doyle
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | | | - Zein Nakhoda
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nima Nassiri
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wesley Yip
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kevin Wayne
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Leo Doumanian
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stuart D Boyd
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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13
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Quality of life up to 10 years after external beam radiotherapy and/or brachytherapy for prostate cancer. Brachytherapy 2018; 17:517-523. [DOI: 10.1016/j.brachy.2018.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 11/23/2022]
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14
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Lazarev S, Thompson MR, Stone NN, Stock RG. Low-dose-rate brachytherapy for prostate cancer: outcomes at >10 years of follow-up. BJU Int 2018; 121:781-790. [PMID: 29319928 DOI: 10.1111/bju.14122] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine biochemical control, survival, and late morbidity with definitive low-dose-rate brachytherapy (LDR-BT) for patients with prostate cancer surviving for >10 years after treatment. PATIENTS AND METHODS We identified 757 men with localised prostate cancer who underwent definitive LDR-BT in the period 1990-2006 and were followed for >10 years at our institution. Biochemical failure-free survival (BFFS), distant metastases-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were selected as study endpoints. Survival was examined using the log-rank test, Kaplan-Meier method, and Cox regression modelling. Urinary, quality of life (QoL), and potency scores at baseline and last follow-up were recorded. RESULTS The median follow-up was 12.5 years (range, 10.1-21.8 years). At the time of analysis, 88.6% of patients were alive, 1.5% died from prostate cancer and 13.9% developed biochemical failure, with 82% of failures occurring in the first decade of follow-up. Overall, 2.3% developed distant metastases. On multivariate analyses, stage T3a-T3b, prostate-specific antigen level of >20 ng/mL, intermediate- and high-risk disease predicted worse BFFS; whereas age >70 years at diagnosis and stage T3a-T3b predicted worse OS. A total biologically effective dose of ≥150 Gy and androgen-deprivation therapy were associated with improved BFFS, but not OS. The overall 17-year rates for BFFS, DMFS, PCSS, and OS were 79, 97, 97, and 72%, respectively. Respective 17-year BFFS rates for low-, intermediate- and high-risk patients were 86, 80, and 65% (P < 0.001), whereas OS rates for the same groups were 82, 73, and 60%, respectively (P = 0.09). Amongst those patients who were potent at baseline, 25% remained potent at the last follow-up. Urinary function and QoL were mainly unaffected. CONCLUSIONS LDR-BT yields excellent survival rates, with a 17-year PCSS rate of 97%. In all, 18% of patients with biochemical relapse failed at >10 years after implantation, which justifies their continued follow-up.
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Affiliation(s)
- Stanislav Lazarev
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marcher R Thompson
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nelson N Stone
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard G Stock
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Does supplemental external beam radiation therapy impact urinary, bowel, and erectile function following permanent prostate brachytherapy?: results of two prospective randomized trials. J Contemp Brachytherapy 2017; 9:403-409. [PMID: 29204160 PMCID: PMC5705829 DOI: 10.5114/jcb.2017.70763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/11/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the impact of supplemental external beam radiation therapy (EBRT) prior to permanent prostate brachytherapy on long term urinary, bowel, and erectile function. Material and methods Patient administered urinary, bowel, and erectile quality of life (QoL) instrument were obtained prior to treatment and following brachytherapy. The study population was comprised of the 457 patients who were alive as of June 2016, had been randomized to two markedly different supplemental EBRT dose regimens and a third arm without supplemental EBRT, and had completed the June 2016 QoL survey. The need for urinary or bowel surgical intervention was prospectively recorded during routine follow-up. Multiple parameters were evaluated for effect on outcomes. Results The urinary catheter was removed on day 0 in 92.1% of patients and 0.4% required a post-implant transurethral prostatic resection (TURP). On average, the International Prostate Symptom Score (IPSS) normalized at week 14. The 10-year rate of urethral strictures was 5.3%. No significant differences were discerned between baseline and post-implant rectal function assessment score (RFAS), and no patient developed a rectal ulcer or fistula. The 10-year potency preservation rate was 50.3%. Supplemental EBRT did not affect urinary, bowel, or erectile function. Urethral strictures were most closely related to bulbomembranous urethral brachytherapy doses, post-implant rectal function to pre-implant hemorroidal bleeding, and RFAS and erectile function to pre-brachytherapy international index of erectile function and age. Conclusions Supplemental EBRT did not significantly effect catheter dependency, IPSS resolution, urethral stricture rate, the need for post-implant TURP, bowel, or erectile function. Careful attention to brachytherapy dose distributions appears to be most important in minimizing post-brachytherapy morbidity.
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Renard-Penna R, Sanchez-Salas R, Barret E, Cosset JM, de Vergie S, Sapetti J, Ingels A, Gangi A, Lang H, Cathelineau X. [Evaluation and results of ablative therapies in prostate cancer]. Prog Urol 2017; 27:887-908. [PMID: 28939336 DOI: 10.1016/j.purol.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/04/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To perform a state of the art about methods of evaluation and present results in ablative therapies for localized prostate cancer. METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 102 articles were analysed. RESULTS Analyse the results of ablative therapies is presently difficult considering the heterogeneity of indications, techniques and follow-up. However, results from the most recent and homogeneous studies are encouraging. Oncologically, postoperative biopsies (the most important criteria) are negative (without any tumor cells in the treated area) in 75 to 95%. Functionally, urinary and sexual pre-operative status is spared (or recovered early) in more than 90% of the patients treated. More and more studies underline also the correlation between the results and the technique used considering the volume of the gland and, moreover, the "index lesion" localization. CONCLUSION The post-treatment pathological evaluation by biopsies (targeted with MRI or, perhaps in a near future, with innovative ultrasonography) is the corner stone of oncological evaluation of ablative therapies. Ongoing trials will allow to standardize the follow-up and determine the best indication and the best techniques in order to optimize oncological and functional results for each patient treated.
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Affiliation(s)
- R Renard-Penna
- Service d'imagerie, hôpitaux Tenon-Pitié Salpêtrière, AP-HP, UPMC université Paris VI, 75013 Paris, France
| | - R Sanchez-Salas
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - E Barret
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - J M Cosset
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - S de Vergie
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - J Sapetti
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - A Ingels
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - A Gangi
- Service de radiologie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France.
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17
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Gnep K, Lizée T, Campillo-Gimenez B, Delpon G, Droupy S, Perrier L, de Crevoisier R. [Toxicity and quality of life comparison of iodine 125 brachytherapy and stereotactic radiotherapy for prostate cancers]. Cancer Radiother 2017; 21:478-490. [PMID: 28888746 DOI: 10.1016/j.canrad.2017.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022]
Abstract
Quality of life is a major issue for good prognostic prostate cancer, for which brachytherapy is one of the reference treatments. Stereotactic Body Radiotherapy (SBRT) is a recent alternative however not yet validated as a standard treatment. This review of the literature reports and compares the toxicities and the quality of life, either after exclusive brachytherapy with iodine 125 or after SBRT. The comparison is made with the limitations of the absence of randomized trial comparing the two treatment techniques. Acute toxicity appears to be lower after SBRT compared to brachytherapy (from 10 to 40 % versus 30 to 40 %, respectively). Conversely, acute and late gastrointestinal toxicity (from 0 to 21 % and from 0 to 10 % of grade 2, respectively) appears more frequent with SBRT. Late urinary toxicity seems identical between both techniques (from 20 to 30 % of grade 2), with a possible urinary flare syndrome. Both treatments have an impact on erectile dysfunction, although it is not possible to conclude that a technique is superior because of the limited data on SBRT. SBRT has better bowel and urinary (irritation or obstruction) quality of life scores than brachytherapy; while sexual and urinary incontinence remain the same. The absence of randomized trial comparing SBRT with brachytherapy for prostate cancers does not allow to conclude on the superiority of one technique over another, thus justifying a phase III medicoeconomic evaluation.
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Affiliation(s)
- K Gnep
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35042 Rennes, France.
| | - T Lizée
- Département de radiothérapie, centre régional de lutte contre le cancer Paul-Papin, institut de cancérologie de l'Ouest, 49100 Angers, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
| | - B Campillo-Gimenez
- Direction de la recherche clinique, centre régional de lutte contre le cancer Eugène-Marquis, 35042 Rennes, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
| | - G Delpon
- Département de radiothérapie, centre régional de lutte contre le cancer René-Gauducheau, institut de cancérologie de l'Ouest, 44805 Saint-Herblain, France
| | - S Droupy
- Département d'urologie, centre hospitalier universitaire de Nîmes, 30029 Nîmes, France
| | - L Perrier
- Centre Léon-Bérard, université Lyon, direction de la recherche clinique et de l'innovation GATE L-SE UMR 5824, 69008 Lyon, France
| | - R de Crevoisier
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35042 Rennes, France; LTSI Inserm 1099, université Rennes 1, 35000 Rennes, France
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18
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Logghe P, Verlinde R, Bouttens F, Van den Broecke C, Deman N, Verboven K, Maes D, Merckx L. Long term outcome and side effects in patients receiving low-dose I125 brachytherapy: a retrospective analysis. Int Braz J Urol 2017; 42:906-917. [PMID: 27532118 PMCID: PMC5066886 DOI: 10.1590/s1677-5538.ibju.2015.0542] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/18/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives: To retrospectively evaluate the disease free survival (DFS), disease specific survival (DSS),overall survival (OS) and side effects in patients who received low-dose rate (LDR) brachytherapy with I125 stranded seeds. Materials and methods: Between july 2003 and august 2012, 274 patients with organ confined prostate cancer were treated with permanent I125 brachytherapy. The median follow-up, age and pretreatment prostate specific antigen (iPSA) was 84 months (12-120), 67 years (50-83) and 7.8 ng/mL (1.14-38), respectively. Median Gleason score was 6 (3-9). 219 patients (80%) had stage cT1c, 42 patients (15.3%) had stage cT2a, 3 (1.1%) had stage cT2b and 3 (1.1%) had stage cT2c. The median D90 was 154.3 Gy (102.7-190.2). Results: DSS was 98.5%.OS was 93.5%. 13 patients (4.7%) developed systemic disease, 7 patients (2.55%) had local progression. In 139 low risk patients, the 5 year biochemical freedom from failure rate (BFFF) was 85% and 9 patients (6.4%) developed clinical progression. In the intermediate risk group, the 5 year BFFF rate was 70% and 5 patients (7.1%) developed clinical progression. Median nPSA in patients with biochemical relapse was 1.58 ng/mL (0.21 – 10.46), median nPSA in patients in remission was 0.51 ng/mL (0.01 – 8.5). Patients attaining a low PSA nadir had a significant higher BFFF (p<0.05). Median D90 in patients with biochemical relapse was 87.2 Gy (51 – 143,1). Patients receiving a high D90 had a significant higher BFFF (p<0.05). Conclusion: In a well selected patient population, LDR brachytherapy offers excellent outcomes. Reaching a low PSA nadir and attaining high D90 values are significant predictors for a higher DFS.
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Affiliation(s)
- Pieter Logghe
- Department of Urology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | - Rolf Verlinde
- Department of Urology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | - Frank Bouttens
- Department of Radiotherapy-Oncology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | | | - Nathalie Deman
- Department of Physics, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | - Koen Verboven
- Department of Physics, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | - Dirk Maes
- Department of Urology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
| | - Luc Merckx
- Department of Urology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium
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19
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Spratt DE, Soni PD, McLaughlin PW, Merrick GS, Stock RG, Blasko JC, Zelefsky MJ. American Brachytherapy Society Task Group Report: Combination of brachytherapy and external beam radiation for high-risk prostate cancer. Brachytherapy 2016; 16:1-12. [PMID: 27771243 DOI: 10.1016/j.brachy.2016.09.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To review outcomes for high-risk prostate cancer treated with combined modality radiation therapy (CMRT) utilizing external beam radiation therapy (EBRT) with a brachytherapy boost. METHODS AND MATERIALS The available literature for high-risk prostate cancer treated with combined modality radiation therapy was reviewed and summarized. RESULTS At this time, the literature suggests that the majority of high-risk cancers are curable with multimodal treatment. Several large retrospective studies and three prospective randomized trials comparing CMRT to dose-escalated EBRT have demonstrated superior biochemical control with CMRT. Longer followup of the randomized trials will be required to determine if this will translate to a benefit in metastasis-free survival, disease-specific survival, and overall survival. Although greater toxicity has been associated with CMRT compared to EBRT, recent studies suggest that technological advances that allow better definition and sparing of critical adjacent structures as well as increasing experience with brachytherapy have improved implant quality and the toxicity profile of brachytherapy. The role of androgen deprivation therapy is well established in the external beam literature for high-risk disease, but there is controversy regarding the applicability of these data in the setting of dose escalation. At this time, there is not sufficient evidence for the omission of androgen deprivation therapy with dose escalation in this population. Comparisons with surgery remain limited by differences in patient selection, but the evidence would suggest better disease control with CMRT compared to surgery alone. CONCLUSIONS Due to a series of technological advances, modern combination series have demonstrated unparalleled rates of disease control in the high-risk population. Given the evidence from recent randomized trials, combination therapy may become the standard of care for high-risk cancers.
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Affiliation(s)
- Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Payal D Soni
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | | - Gregory S Merrick
- Schiffler Cancer Center, Department of Radiation Oncology, Wheeling Jesuit University, Wheeling, WV; Department of Urology, Wheeling Hospital, Wheeling, WV
| | - Richard G Stock
- Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY
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20
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Cosset JM, Flam T, Belin L, Thiounn N, Pierrat N, Pontvert D, Wakil G, Savignoni A, Chauveinc L. Long-term results of permanent implant prostate cancer brachytherapy: A single-institution study of 675 patients treated between 1999 and 2003. Cancer Radiother 2016; 20:261-7. [DOI: 10.1016/j.canrad.2016.02.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 10/21/2022]
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21
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Focal prostate brachytherapy with 103 Pd seeds. Phys Med 2016; 32:459-64. [DOI: 10.1016/j.ejmp.2016.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/07/2016] [Accepted: 03/14/2016] [Indexed: 12/27/2022] Open
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22
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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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23
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Burte C, Quintens H. Place du sexologue dans le parcours de soins en cancérologie : expérience clinique et proposition de protocole dans la prise en charge des troubles sexuels autour de la prostatectomie. SEXOLOGIES 2015. [DOI: 10.1016/j.sexol.2015.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Veccia A, Caffo O, Fellin G, Mussari S, Ziglio F, Maines F, Tomio L, Galligioni E. Impact of post-implant dosimetric parameters on the quality of life of patients treated with low-dose rate brachytherapy for localised prostate cancer: results of a single-institution study. Radiat Oncol 2015; 10:130. [PMID: 26054532 PMCID: PMC4464626 DOI: 10.1186/s13014-015-0434-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/01/2015] [Indexed: 11/12/2022] Open
Abstract
Background To assess the relationship between dosimetric parameters and the quality of life (QL) outcomes of patients with low-intermediate-risk localised prostate cancer (LPC) treated with low-dose-rate brachytherapy (LDR-BT). Materials and methods We evaluated the participants in two consecutive prospective studies of the QL of patients treated with LDR-BT for LPC. QL was evaluated by means of a patient-completed questionnaire assessing non functional [physical (PHY) and psychological (PSY) well-being, physical autonomy (POW), social relationships (REL)] and functional scales [urinary (URI), rectal (REC), and sexual (SEX) function]; a scale for erectile function (ERE) was included in the second study. Urethra (D10 ≤ 210 Gy) and rectal wall constraints (V100 ≤ 0.5 cc) were used for pre-planning dosimetry and were assessed with post planning computerized tomography one month later for each patient. Results QL was assessed in 251 LPC patients. Dosimetry did not influence the non-functional scales. As expected, a progressive impairment in sexual and erectile function was reported one month after LDR-BT, and became statistically significant after the third year. Rectal function significantly worsened after LDR-BT, but the differences progressively decreased after the 1-year assessment. Overall urinary function significantly worsened immediately after LDR-BT and then gradually improved over the next three years. Better outcomes were reported for V100 rectal wall volumes of ≤ 0.5 cc and D10 urethra values of ≤ 210 Gy. Conclusions The findings of this study show that dosimetric parameters influence only functional QL outcomes while non-functional outcomes are only marginally influenced.
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Affiliation(s)
- Antonello Veccia
- Medical Oncology Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Orazio Caffo
- Medical Oncology Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Giovanni Fellin
- Radiotherapy Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Salvatore Mussari
- Radiotherapy Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Francesco Ziglio
- Health Physics Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Francesca Maines
- Medical Oncology Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Luigi Tomio
- Radiotherapy Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Enzo Galligioni
- Medical Oncology Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
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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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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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Marina O, Warner J, Ye H, Grills IS, Shah C, Wallace M, Gustafson GS, Brabbins DS, Martinez AA, Krauss DJ. An age-corrected matched-pair study of erectile function in patients treated with dose-escalated adaptive image-guided intensity-modulated radiation therapy vs. high-dose-rate brachytherapy for prostate cancer. Brachytherapy 2013; 13:163-8. [PMID: 24295963 DOI: 10.1016/j.brachy.2013.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/30/2013] [Accepted: 10/04/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare erectile dysfunction (ED) after adaptive dose-escalated image-guided intensity-modulated radiotherapy (IG-IMRT) and high-dose-rate interstitial brachytherapy (HDR) monotherapy. METHODS AND MATERIALS Low- and intermediate-risk prostate cancer patients treated with IG-IMRT or HDR were matched on pretreatment ED, age, Gleason score, T-stage, and prostate specific antigen. Patients who received androgen deprivation therapy were excluded. ED was graded by Common Terminology Criteria for Adverse Events v4. Actuarial rates of ED were computed by the Kaplan-Meier method. RESULTS There were 384 patients with median followup of 2.0 years (0.5-6.1) for IG-IMRT and 2.0 years (0.5-8.7) for HDR. The median IG-IMRT dose was 75.6 Gy and HDR dose 38 Gy in four fractions. For patients with no pretreatment ED, actuarial rates of requiring intervention (Grade ≥2 ED) at 3 years were 31% for IG-IMRT and 19% for HDR (p=0.23), and impotence despite medical intervention (Grade 3) were 0% for IG-IMRT and 6% for HDR (p=0.06). For patients with Grade 1 pretreatment ED, Grade ≥2 ED at 3 years were 47% for IG-IMRT and 34% for HDR (p=0.79), and Grade 3 ED were 15% in both groups (p=0.59). For patients with Grade 2 pretreatment ED, Grade 3 ED at 3 years were 22% for IG-IMRT and 37% for HDR (p=0.70). No variables were predictive of Grade ≥2 ED following treatment. CONCLUSIONS Rates of ED requiring medical intervention for both IG-IMRT and HDR are low and equivalent. Even patients with ED before treatment are likely to maintain potency with medication use at 3 years following treatment.
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Affiliation(s)
- Ovidiu Marina
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | | | - Hong Ye
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Chirag Shah
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Michelle Wallace
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Gary S Gustafson
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Donald S Brabbins
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI
| | - Alvaro A Martinez
- Michigan HealthCare Professionals/21st Century Oncology, Farmington Hills, MI
| | - Daniel J Krauss
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI.
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Five-year potency preservation after iodine-125 prostate brachytherapy. Int J Clin Oncol 2013; 19:940-5. [PMID: 24170247 DOI: 10.1007/s10147-013-0632-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND We aimed to evaluate long-term erectile function following prostate brachytherapy, based on patient characteristics and treatment factors. METHODS Between 2003 and 2006, 665 men with localized prostate cancer were treated with (125)I permanent seed implantation. None was given adjuvant hormone therapy. Erectile function was assessed before treatment, and at 6 months, 1, 2, 3, 4 and 5 years after implantation using the Mount Sinai Erectile Function Score (MSEFS) of 0-3 (0 = no erections, 1 = erections insufficient for intercourse, 2 = suboptimal erections but sufficient for intercourse, 3 = normal erectile function). Potency was defined as score 2 or 3, and 382 men were potent before treatment. Univariate and multivariate analyses were performed on the data from these 382 patients to identify variables associated with potency preservation. RESULTS In patients who were potent before treatment, the actuarial potency preservation rate fell to 46.2 % at 6 months after brachytherapy, and then slowly recovered reaching 52.0 % at 5 years after brachytherapy. In multivariate logistic regression analysis, patient age (p = 0.04) and pre-treatment MSEFS (p < 0.001) were predictors of 5-year potency preservation. Neoadjuvant hormone therapy affected potency preservation only at 6 months after brachytherapy. CONCLUSIONS Patient age at implantation and pre-treatment erectile function are predictive factors for the development of erectile dysfunction following prostate brachytherapy.
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de Castro Abreu AL, Bahn D, Leslie S, Shoji S, Silverman P, Desai MM, Gill IS, Ukimura O. Salvage focal and salvage total cryoablation for locally recurrent prostate cancer after primary radiation therapy. BJU Int 2013; 112:298-307. [PMID: 23826840 DOI: 10.1111/bju.12151] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To present the oncological and functional outcomes of salvage focal (SFC) and salvage total (STC) cryoablation for recurrent prostate cancer (PCa) after failed primary radiotherapy. PATIENTS AND METHODS From March 2003 to August 2010, 50 men with biopsy-proven unilateral (n = 25) or bilateral (n = 25) radio-recurrent PCa underwent SFC or STC, respectively. Patients were assessed after treatment by prostate-specific antigen (PSA) testing, transrectal ultrasonography, biopsy and questionnaires. Biochemical failure (BF) was defined using the Phoenix criteria (PSA nadir + 2 mg/mL). Data were prospectively collected and retrospectively analysed. RESULTS The median pre-cryoablation PSA level and Gleason score were, respectively, 2.8 ng/mL and 7 for SFC, and 3.9 ng/mL and 7 for STC. The median follow-up was 31 and 53 months (P = 0.004) for SFC and STC, respectively. Oncological outcomes were as follows: no patient died; one patient who underwent STC developed bone metastases; eight patients who underwent SFC and three who underwent STC had BF and the 5-year BF-free survival rates were 54 and 86%, respectively. In those patients without BF, the mean PSA decreased by 86% for SFC and 90% for STC within the first year and remained stable. Functional outcomes were as follows: new onset urinary incontinence occurred in three (13%) patients in the STC group, whereas no patient in the SFC group developed incontinence (P = 0.10); Two of seven patients in the SFC group retained postoperative potency, but none of the four potent patients in the STC group recovered potency postoperatively (P = 0.48); one (4%) patient in the STC group developed a recto-urethral fistula, but none occurred in the SFC group (P = 0.48). CONCLUSIONS SFC and STC are feasible and safe with acceptable mid-term oncological outcomes. For carefully selected patients, SFC is an option that could be associated with lower treatment-related morbidity compared with STC. Although longer follow-up and more patient numbers are needed, our initial oncological and functional outcomes of SFC and STC are encouraging.
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Affiliation(s)
- Andre Luis de Castro Abreu
- USC Institute of Urology, Hillard and Roclyn Herzog Center for Prostate Cancer Focal Therapy, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
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Njomnang Soh P, Delaunay B, Thoulouzan M, Jonca F, Bachaud JM, Delannes M, Soulie M, Huyghe E. Erectile function after permanent 125I prostate brachytherapy for localized prostate cancer. Basic Clin Androl 2013; 23:2. [PMID: 25780566 PMCID: PMC4346293 DOI: 10.1186/2051-4190-23-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE To analyze erectile function in men treated by prostate brachytherapy (PB) for localized prostate cancer. MATERIAL AND METHODS Of a series of 270 sexually active men treated by PB, 241 (89%), mean age 65 yr (range, 43-80 yr), participated in a study on erectile function that was evaluated using the International Index of Erectile Function 5-item (IIEF-5) questionnaire before implantation and by postal survey after a mean follow-up of 36 months (range, 6-70 months). RESULTS After PB, 27 patients (11%) had no erectile dysfunction (ED), 36 (15%) had mild ED, 58 (24%) had mild to moderate ED, 24 (10%) had moderate ED, 53 (22%) had severe ED and 43 (18%) were not sexually active. In patients with a preimplant IIEF score >12 (cut-off for intercourse with penetration), 73% had a deterioration of erectile function by at least one class after PB. Risk factors for ED after PB were age, preimplant IIEF score and prostate volume. Median time to ED onset was 16 months and was shorter with androgen deprivation (p = 0.007), diabetes (p = 0.03) and age over 55 (p = 0.01). CONCLUSIONS Following PB, the majority of patients progressively develop or major ED after a free interval that may last several months. SUPPORT Ligue Nationale contre le Cancer, France.
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Affiliation(s)
- Patrice Njomnang Soh
- Department of Andrology, University Hospital Paule de Viguier, Paul Sabatier University, EA 3694 Toulouse, France
| | - Boris Delaunay
- Department of Andrology, University Hospital Paule de Viguier, Paul Sabatier University, EA 3694 Toulouse, France ; Department of Urology, University Hospital of rangueil, Toulouse, France
| | | | | | | | | | - Michel Soulie
- Department of Urology, University Hospital of rangueil, Toulouse, France
| | - Eric Huyghe
- Department of Andrology, University Hospital Paule de Viguier, Paul Sabatier University, EA 3694 Toulouse, France ; Department of Urology, University Hospital of rangueil, Toulouse, France ; Département d'Urologie CHU Rangueil, 1 av. Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France
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Droupy S, Al Said B, Lechevallier É, Colson MH, Giuliano F. Sexualité et cancer de la prostate. Prog Urol 2013; 23:696-711. [DOI: 10.1016/j.purol.2013.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 03/18/2013] [Indexed: 01/09/2023]
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Hennequin C, Cormier L, Richaud P, Bastide C, Beuzeboc P, Fromont G, Mongiat-Artus P, Peyromaure M, Ploussard G, Renard-Penna R, Rozet F, Soulié M, Salomon L. Curiethérapie exclusive du cancer de la prostate par implants permanents : indications et résultats. Revue du CC-AFU. Prog Urol 2013; 23:378-85. [DOI: 10.1016/j.purol.2012.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 11/27/2022]
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[Sexual function after permanent seed implant prostate brachytherapy]. Nihon Hinyokika Gakkai Zasshi 2012; 103:599-603. [PMID: 23120993 DOI: 10.5980/jpnjurol.103.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The aim of this study was to evaluate the long-term effects of permanent seed implant prostate brachytherapy (BT) on sexual function (SF). MATERIALS AND METHODS From September 2003 to July 2005, 56 patients underwent radical retropubic prostatectomy (RRP) without any hormone therapy, while 353 patients had undergone BT without any adjuvant hormone therapy in a single institute. Out of these 353 patients in the BT group, 305 patients received neoadjuvant hormone therapy (BT NHT + group), while 48 did not (BT NHT - group). SF was prospectively evaluated using the UCLA Prostate Cancer Index (UCLA-PCI). Potency was defined as the UCLA-PCI Q26 point of > or = 3. RESULT The preimplant UCLA-PCI scores of SF for BT NHT - and BT NHT + groups were 50.9 and 13.4, respectively. The SF score of the NHT - group post operatively decreased to 38.9 within 6 months, but was maintained at the same level after that. With the recovery of the androgen, SF score of the NHT + group improved after BT: however, it did not reach up to that of the NHT - group. In the univariate analysis, patient's age was the only predictive factor for SF after BT. Thirty-four out of 48 patients in the BT NHT - group and 23 out of 56 patients in the RRP group showed adequate potency before surgery. Their 5-year potency preservation rate was 73.6% in the BT NHT - group and 4.3% in the RRP group. CONCLUSION SF slightly decreased immediately after BT but was usually maintained during the course observation for 5 years. The 5-year SF preservation rate after BT was 73.6%.
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Ilic D, Hindson B, Duchesne G, Millar JL. A randomised, double-blind, placebo-controlled trial of nightly sildenafil citrate to preserve erectile function after radiation treatment for prostate cancer. J Med Imaging Radiat Oncol 2012; 57:81-8. [DOI: 10.1111/j.1754-9485.2012.02461.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/01/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Dragan Ilic
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne; Victoria; Australia
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Colson MH, Lechevallier E, Rambeaud JJ, Alimi JC, Faix A, Gravis G, Hannoun-Levi JM, Quintens H, Rébillard X, Droupy S. Sexualité et cancer de la prostate. Prog Urol 2012; 22 Suppl 2:S72-92. [DOI: 10.1016/s1166-7087(12)70039-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stember DS, Mulhall JP. The concept of erectile function preservation (penile rehabilitation) in the patient after brachytherapy for prostate cancer. Brachytherapy 2012; 11:87-96. [DOI: 10.1016/j.brachy.2012.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Singh DK, Hersey K, Perlis N, Crook J, Jarvi K, Fleshner N. The Effect of Radiation on Semen Quality and Fertility in Men Treated With Brachytherapy for Early Stage Prostate Cancer. J Urol 2012; 187:987-9. [DOI: 10.1016/j.juro.2011.10.141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Indexed: 11/26/2022]
Affiliation(s)
- Dilpreet K. Singh
- Division of Urology, Princess Margaret Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Karen Hersey
- Division of Urology, Princess Margaret Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Nathan Perlis
- Division of Urology, Princess Margaret Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Juanita Crook
- British Columbia Cancer Agency, Kelowna, British Columbia, Canada
| | - Keith Jarvi
- Division of Urology, Princess Margaret Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada
- Samuel Lunelfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- The Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Neil Fleshner
- Division of Urology, Princess Margaret Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada
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Functional Outcomes and Complications Following Radiation Therapy for Prostate Cancer: A Critical Analysis of the Literature. Eur Urol 2012; 61:112-27. [DOI: 10.1016/j.eururo.2011.09.027] [Citation(s) in RCA: 211] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 09/27/2011] [Indexed: 12/13/2022]
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Kollmeier MA, Pei X, Algur E, Yamada Y, Cox BW, Cohen GN, Zaider M, Zelefsky MJ. A comparison of the impact of isotope ((125)I vs. (103)Pd) on toxicity and biochemical outcome after interstitial brachytherapy and external beam radiation therapy for clinically localized prostate cancer. Brachytherapy 2011; 11:271-6. [PMID: 22192495 DOI: 10.1016/j.brachy.2011.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/03/2011] [Accepted: 11/09/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To compare biochemical outcomes and morbidity associated with iodine-125 ((125)I) and palladium-103 ((103)Pd) brachytherapy as part of combined modality therapy for clinically localized prostate cancer. METHODS AND MATERIALS Between October 2002 and December 2008, 259 patients underwent prostate brachytherapy ((125)I prescription dose, 110Gy: n=199; (103)Pd prescription dose, 100Gy: n=60) followed by external beam radiotherapy (median dose, 50.4Gy). Eighty-seven patients also received neoadjuvant androgen deprivation therapy. Toxicities were recorded with CTCAE v 3.0, International Prostate Symptoms Score (IPSS), and International Index of Erectile Function questionnaires. RESULTS Overall, acute Grade ≥2 genitourinary toxicity occurred in 21% and 30% of patients treated with (125)I and (103)Pd, respectively (p=0.16). There were no significant differences in IPSS change or urinary quality-of-life scores between the isotopes at 4, 6, or 12 months (p=0.20, 0.21, and 1.0, respectively). IPSS resolution occurred at a median of 11 and 6 months for (125)I and (103)Pd patients, respectively (p=0.03). On multivariate analysis, only the use of neoadjuvant androgen deprivation therapy was predictive of time to IPSS resolution (p=0.046). Late Grade ≥2 gastrointestinal toxicity occurred in 7% of (125)I patients and 6% of patients treated with (103)Pd. Of 129 potent patients at baseline, there was better erectile function in patients who received (103)Pd (p=0.02); however, the followup was shorter for these patients. The 5-year prostate-specific antigen relapse-free survival for (125)I and (103)Pd patients was 95.2% and 98.2% (p=0.73), respectively. CONCLUSION There were no differences in acute or long-term genitourinary or gastrointestinal toxicity between (125)I and (103)Pd in combined modality therapy for prostate cancer. There may be less erectile toxicity with the use of (103)Pd; however, additional followup of these patients is needed. There was no significant difference in 5-year prostate-specific antigen relapse-free survival between (103)Pd and (125)I.
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Affiliation(s)
- Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Emara AM, Chadwick E, Nobes JP, Abdelbaky AM, Laing RW, Langley SE. Long-term toxicity and quality of life up to 10 years after low-dose rate brachytherapy for prostate cancer. BJU Int 2011; 109:994-1000. [DOI: 10.1111/j.1464-410x.2011.10460.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bittner N, Merrick GS, Galbreath RW, Butler WM, Lief JH, Allen ZA, Wallner KE. Erectile dysfunction is predictive of all-cause mortality in patients with prostate cancer treated with permanent interstitial brachytherapy. BJU Int 2011; 109:220-5. [DOI: 10.1111/j.1464-410x.2011.10280.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aaltomaa S, Kärjä V, Kainulainen S. Secondary squamous cell prostate cancer after prostate brachytherapy treatment. ACTA ACUST UNITED AC 2011; 45:356-8. [DOI: 10.3109/00365599.2011.562237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - S. Kainulainen
- Radiological Clinics, Kuopio University Hospital, Kuopio, Finland
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Droupy S. Dysfonctions sexuelles après irradiation pour cancer de la prostate. Cancer Radiother 2010; 14:504-9. [DOI: 10.1016/j.canrad.2010.07.223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Accepted: 07/13/2010] [Indexed: 11/30/2022]
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Marçon N, Cormier L, Peiffert D, Mangin P. Étude de la fonction sexuelle à long terme après curiethérapie pour un cancer localisé de la prostate. Prog Urol 2010; 20:284-91. [DOI: 10.1016/j.purol.2009.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 10/02/2009] [Accepted: 10/16/2009] [Indexed: 11/16/2022]
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Stock RG, Stone NN. Current Topics in the Treatment of Prostate Cancer with Low-Dose-Rate Brachytherapy. Urol Clin North Am 2010; 37:83-96, Table of Contents. [DOI: 10.1016/j.ucl.2009.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Curiethérapie de prostate par iode 125 : facteurs pronostiques de longue durée de toxicité urinaire, digestive et sexuelle. Cancer Radiother 2009; 13:721-30. [DOI: 10.1016/j.canrad.2009.08.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 07/22/2009] [Accepted: 08/06/2009] [Indexed: 11/17/2022]
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