1
|
Fujita N, Iwane T, Tamura Y, Okamoto T, Yamamoto H, Hatakeyama S, Yoneyama T, Hashimoto Y, Kobayashi W, Ohyama C. Associations of remaining teeth number, periodontal disease, and occlusal support status with erectile dysfunction in community-dwelling men. Int J Urol 2024; 31:869-875. [PMID: 38695270 DOI: 10.1111/iju.15472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/15/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES Several systematic reviews and meta-analyses have reported positive relationships between erectile dysfunction (ED) and periodontal disease. However, no study has evaluated the relationships of occlusal support status and the number of remaining teeth with ED. The aim of the present study was to investigate the relationships between ED and the remaining teeth number, periodontal disease, and occlusal support status. METHODS This study included 400 community-dwelling men. Periodontal health status and occlusal support condition were evaluated using the Community Periodontal Index (CPI) and Eichner classification. Multivariable analyses were performed to evaluate the relationships between ED and the remaining teeth number, periodontal disease, and occlusal support status. RESULTS The median age was 53 years. Of the 400 men, 333 (83%) were classified into ED group. In univariable analyses, remaining teeth number, CPI score, and Eichner classification were significantly associated with ED. In multivariable analyses, the remaining teeth number (odds ratio [OR]: 0.907, p = 0.114) and CPI score (OR: 0.978, p = 0.864) were not significantly associated with ED, whereas the Eichner classification was independently and significantly associated with ED (OR: 3.490, p = 0.042). CONCLUSIONS Poor occlusal support status was significantly associated with ED in community-dwelling men, as opposed to remaining teeth number and periodontal health status.
Collapse
Affiliation(s)
- Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuro Iwane
- Research Institute of Health Innovation, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshihiro Tamura
- Department of Dentistry and Oral Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Wataru Kobayashi
- Department of Dentistry and Oral Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
2
|
Carbunaru S, Sun Z, McCall C, Ofori B, Marshall N, Wang H, Abern M, Liu L, Hollowell CMP, Sharifi R, Vidal P, Kajdacsy‐Balla A, Sekosan M, Ferrer K, Wu S, Gallegos M, Gann PH, Moreira D, Sharp LK, Ferrans CE, Murphy AB. Impact of genomic testing on urologists' treatment preference in favorable risk prostate cancer: A randomized trial. Cancer Med 2023; 12:19690-19700. [PMID: 37787097 PMCID: PMC10587942 DOI: 10.1002/cam4.6615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION The Oncotype Dx Genomic Prostate Score (GPS) is a 17-gene relative expression assay that predicts adverse pathology at prostatectomy. We conducted a novel randomized controlled trial to assess the impact of GPS on urologist's treatment preference for favorable risk prostate cancer (PCa): active surveillance versus active treatment (i.e., prostatectomy/radiation). This is a secondary endpoint from the ENACT trial which recruited from three Chicago hospitals from 2016 to 2019. METHODS Ten urologists along with men with very low to favorable-intermediate risk PCa were included in the study. Participants were randomly assigned to standardized counseling with or without GPS assay. The main outcome was urologists' preference for active treatment at Visit 2 by study arm (GPS versus Control). Multivariable best-fit binary logistic regressions were constructed to identify factors independently associated with urologists' treatment preference. RESULTS Two hundred men (70% Black) were randomly assigned to either the Control (96) or GPS arm (104). At Visit 2, urologists' preference for prostatectomy/radiation almost doubled in the GPS arm to 29.3% (29) compared to 14.1% (13) in the Control arm (p = 0.01). Randomization to the GPS arm, intermediate NCCN risk level, and lower patient health literacy were predictors for urologists' preference for active treatment. DISCUSSION Limitations included sample size and number of urologists. In this study, we found that GPS testing reduced urologists' likelihood to prefer active surveillance. CONCLUSIONS These findings demonstrate how obtaining prognostic biomarkers that predict negative outcomes before treatment decision-making might influence urologists' preference for recommending aggressive therapy in men eligible for active surveillance.
Collapse
Affiliation(s)
- Samuel Carbunaru
- Department of UrologyNew York University Langone School of MedicineNew YorkNew YorkUSA
| | - Zequn Sun
- Department of Preventive MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Cordero McCall
- Medical College of Wisconsin Medical SchoolMilwaukeeWisconsinUSA
| | - Bernice Ofori
- Department of UrologyNorthwestern University, Feinberg School of MedicineChicagoIllinoisUSA
| | - Norma Marshall
- Department of UrologyNorthwestern University, Feinberg School of MedicineChicagoIllinoisUSA
| | - Heidy Wang
- Division of Epidemiology and BiostatisticsUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Michael Abern
- Division of UrologyDuke UniversityDurhamNorth CarolinaUSA
| | - Li Liu
- Division of Epidemiology and BiostatisticsUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | | | | | | | | | - Marin Sekosan
- Department of PathologyCook County Health and Hospital SystemChicagoIllinoisUSA
| | - Karen Ferrer
- Department of PathologyCook County Health and Hospital SystemChicagoIllinoisUSA
| | - Shoujin Wu
- Pathology and Laboratory ServicesJesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Marlene Gallegos
- Pathology and Laboratory ServicesJesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Peter H. Gann
- Department of PathologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Daniel Moreira
- Department of UrologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Lisa K. Sharp
- Institute for Health Research and PolicyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Carol E. Ferrans
- Department of Biobehavioral Nursing ScienceUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Adam B. Murphy
- Department of UrologyNorthwestern University, Feinberg School of MedicineChicagoIllinoisUSA
- Division of UrologyCook County HealthChicagoIllinoisUSA
- Division of UrologyJesse Brown VA Medical CenterChicagoIllinoisUSA
| |
Collapse
|
3
|
Ailloud A, Udrescu C, Horn S, Enachescu C, Créhange G, Sargos P, Supiot S, Zilli T, Lapierre A, Chapet O. [Relationship between doses to anatomical structures and erectile dysfunction after radiotherapy for prostate cancer: A systematic review]. Cancer Radiother 2023; 27:548-561. [PMID: 37596125 DOI: 10.1016/j.canrad.2023.07.010] [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: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/20/2023]
Abstract
PURPOSE During prostatic radiotherapy, damage to several anatomical structures could be the cause of erectile dysfunction: corpora cavernosa, internal pudendal arteries, penile bulb, and neurovascular bundles. Numerous studies have analysed the correlations between the dose received by these structures and erectile function. The objective of this article is to make a systematic review on current knowledge. MATERIALS AND METHODS A systematic review was performed in the Medline database using the search engine PubMed. Keywords for the search included: erectile dysfunction, penile bulb, corpora cavernosa, cavernosum, neurovascular bundles, radiation therapy, cancer, prostate cancer. The selected articles must study a correlation between erectile dysfunction and the dose received by anatomical structures. A total of 152 articles were identified. Of these 152 articles, 45 fulfilled the defined selection criteria. RESULTS For corpora cavernosa, seven studies were identified, only two studies demonstrated a significant correlation between the dose received by corpora cavernosa and the occurrence of erectile dysfunction. For penile bulb, only 15 of 23 studies showed a correlation. A mean dose on the penile bulb greater than 20Gy was found to be predictive of erectile dysfunction. None of the eight trials concerning neurovascular bundles succeeded to show a correlation between dose and erectile dysfunction. Only one study evaluated the relationship between the dose received by internal pudendal arteries and erectile dysfunction but was found to be negative. However, vessels-sparing studies showed good results on erectile function preservation without compromising the target volume. CONCLUSION We currently have little data to show a correlation between erectile dysfunction and sexual structures. It would be necessary to have additional prospective studies evaluating the impact of an optimization on these sexual structures on erectile dysfunction.
Collapse
Affiliation(s)
- A Ailloud
- Département de radiothérapie-oncologie, hôpital Lyon-Sud, Pierre-Bénite, France
| | - C Udrescu
- Département de radiothérapie-oncologie, hôpital Lyon-Sud, Pierre-Bénite, France; Université Claude-Bernard Lyon 1, Pierre-Bénite, France
| | - S Horn
- Département de radiothérapie-oncologie, hôpital Lyon-Sud, Pierre-Bénite, France
| | - C Enachescu
- Département de radiothérapie-oncologie, hôpital Lyon-Sud, Pierre-Bénite, France
| | - G Créhange
- Département de radiothérapie-oncologie, institut Curie, Paris, France; Université PSL, université Paris-Saclay, U1288, Inserm Lito, Orsay, France
| | - P Sargos
- Département de radiothérapie-oncologie, institut Bergonié, Bordeaux, France
| | - S Supiot
- Département de radiothérapie-oncologie, institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - T Zilli
- Département de radiothérapie-oncologie, hôpitaux universitaires de Genève, Genève, Suisse; Université de médecine de Genève, Genève, Suisse
| | - A Lapierre
- Département de radiothérapie-oncologie, hôpital Lyon-Sud, Pierre-Bénite, France; Université Claude-Bernard Lyon 1, Pierre-Bénite, France
| | - O Chapet
- Département de radiothérapie-oncologie, hôpital Lyon-Sud, Pierre-Bénite, France; Université Claude-Bernard Lyon 1, Pierre-Bénite, France.
| |
Collapse
|
4
|
Lonergan PE, Baskin A, Greenberg SA, Mohamad O, Washington SL, Zhao S, Cowan JE, Broering JM, Nguyen HG, Cooperberg MR, Breyer BN, Carroll PR. The Long-term Incidence and Quality of Life Outcomes Associated With Treatment-Related Toxicities of External Beam Radiotherapy for Prostate Cancer. Urology 2023; 178:114-119. [PMID: 37244430 DOI: 10.1016/j.urology.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the long-term incidence of treatment-related toxicities and quality of life (QOL) outcomes associated with toxicity after external beam radiotherapy (EBRT) for prostate cancer. METHODS We identified all men who had EBRT between 1994 and 2017 from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a longitudinal, nationwide prostate cancer registry. CaPSURE was queried for patient-reported and International Classification of Diseases-9/10 and Current Procedural Terminology codes. The Medical Outcomes Studies Short Form 36 and the University of California, Los Angeles Prostate Cancer Index were used to provide measures of general health, sexual, urinary, and bowel function. Repeated measures mixed models were used to determine QOL change after onset of toxicity. RESULTS From a total of 15,332, 1744 (11.4%) men had EBRT. The median follow-up was 7.9years (interquartile range [IQR] 4.3-12.7). The median time to onset of any toxicity including urinary pad usage in 265 (15.4% at 8years) men was 4.3years (IQR 1.8-8.0). The most frequent toxicity was hemorrhagic cystitis (104, 5.9% at 8years) after a median of 3.7years (1.3-7.8), gastrointestinal (48, 2.7% at 8years) after a median of 4.2years (IQR 1.3-7.8), followed by urethral stricture (47, 2.4% at 8years) after a median of 3.7years (IQR 1.9-9.1). Repeated measures mixed models found that onset of hemorrhagic cystitis was associated with change in general health over time. CONCLUSION EBRT for prostate cancer is associated with distinct treatment-related toxicities which can occur many years after treatment and can affect QOL. These results may help men understand the long-term implications of treatment decisions.
Collapse
Affiliation(s)
- Peter E Lonergan
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Department of Urology, St. James's Hospital, Dublin, Ireland; Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Avi Baskin
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Scott A Greenberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Osama Mohamad
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA
| | - Samuel L Washington
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Shoujun Zhao
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Janet E Cowan
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Jeanette M Broering
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Hao G Nguyen
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Peter R Carroll
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| |
Collapse
|
5
|
Bernal J, Venkatesan K, Martins FE. Erectile Dysfunction in Pelvic Cancer Survivors and Current Management Options. J Clin Med 2023; 12:jcm12072697. [PMID: 37048780 PMCID: PMC10095222 DOI: 10.3390/jcm12072697] [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: 01/17/2023] [Revised: 03/18/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Pelvic malignancies, including prostate, rectal, and bladder cancers, are among the most frequent malignancies found in the male population. These issues are most effectively and commonly treated with radiotherapy and/or surgery. However, these treatments can cause collateral damage, resulting in significant impacts on quality of life, with erectile dysfunction being one of the most frequent postoperative complications. Currently, there are several treatment options for erectile dysfunction, including oral phosphodiesterase type 5 inhibitors, vacuum erection devices, intracorporeal injections, and penile prosthesis. The latter has shown to be an effective and safe technique, with results comparable to those obtained by patients without pelvic surgery or radiotherapy. The results of early penile rehabilitation programs are promising and they have been incorporated into a greater proportion of treatment plans more recently, with varying degrees of success. In this narrative review, we summarize the literature on erectile dysfunction after pelvic cancer treatments and its management.
Collapse
Affiliation(s)
- Jose Bernal
- Department of Urology, Hospital Sotero del Rio/Clinica Indisa, Santiago 13123, Chile
| | - Krishnan Venkatesan
- Department of Urology, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Francisco E Martins
- Department of Urology, School of Medicine, University of Lisbon, Hospital Santa Maria, 1649-035 Lisbon, Portugal
| |
Collapse
|
6
|
Penile Rehabilitation after Prostate Cancer Treatment: Which Is the Right Program? URO 2023. [DOI: 10.3390/uro3010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The management of sexual complications after treatment of localized prostate cancer, such as erectile dysfunction, changes in the length of the penis, pain during sexual intercourse, and lack of orgasm, is still an unsolved problem with an important impact on patients’ quality of life. In this review, we summarize the current scientific literature about the rehabilitation of erectile dysfunction after prostate cancer treatment. The therapy for penile rehabilitation includes different types of treatments: the combination of phosphodiesterase type 5 inhibitors (PDE5-I) and the vacuum erectile device (VED) are considered first-line treatment options. When therapy begins, the duration of treatment, the dosage and the drug used all play very important roles in the treatment outcome. Intracavernous injection (ICI) therapy represents the second-line option for patients ineligible for PDE5-I therapy. Technological development has led to the emergence of devices for the stimulation of the penis without the use of drugs, such as penile vibratory stimulation (PVS) for stimulation of ejaculation in spinal cord injury and low-intensity extracorporeal shockwave therapy (LIESWT). The rapid diffusion of the latter, thanks to its easy use, attains good results without side effects. The panorama of penile rehabilitation after PC treatments is vast and many studies are needed, especially on new technologies, to find the best therapeutic regimen possible, personalized to the patient’s characteristics and the type of treatment for PC.
Collapse
|
7
|
Fujita N, Ishida M, Iwane T, Suganuma H, Matsumoto M, Hatakeyama S, Yoneyama T, Hashimoto Y, Mikami T, Itoh K, Ohyama C. Association between Advanced Glycation End-Products, Carotenoids, and Severe Erectile Dysfunction. World J Mens Health 2023:41.e17. [PMID: 36649922 DOI: 10.5534/wjmh.220154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/16/2022] [Accepted: 10/06/2022] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To investigate the association between skin advanced glycation end-products (AGEs) levels, blood antioxidative vitamin and carotenoid concentrations, and severe erectile dysfunction (ED) in community-dwelling men. MATERIALS AND METHODS This cross-sectional study used the 5-Item International Index of Erectile Function to identify 335 community-dwelling men with ED. The accumulation of skin AGEs was assessed noninvasively by measuring skin autofluorescence. Background-adjusted multivariable logistic regression analyses using the inverse probability of treatment weighting method were performed to evaluate the effects of AGEs, vitamins, and carotenoids on severe ED. Moreover, multiple linear regression analyses were performed to assess the association between skin AGEs levels and serum carotenoid concentrations. RESULTS The median age of study participants was 57 years. Of the 335 men, 289 (86.3%) and 46 (13.7%) were classified into the mild/moderate and severe ED groups, respectively. Multivariable analyses revealed that skin AGEs levels, blood vitamins C and E, lutein, zeaxanthin, β-cryptoxanthin, α-carotene, β-carotene, total lycopene, and cis-lycopenes concentrations were significantly associated with severe ED, whereas all-trans lycopene concentrations were not. In the multiple linear regression analyses, serum zeaxanthin concentrations were negatively and significantly correlated with skin AGEs levels. CONCLUSIONS Higher skin AGEs levels and lower blood antioxidative vitamin and carotenoid concentrations were significantly associated with severe ED. Serum zeaxanthin levels were negatively and significantly correlated with skin AGEs levels, suggesting the possible effects of zeaxanthin on ED by decreasing tissue AGEs levels.
Collapse
Affiliation(s)
- Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Mizuri Ishida
- Innovation Center for Health Promotion, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuro Iwane
- Innovation Center for Health Promotion, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroyuki Suganuma
- Nature & Wellness Research Department, Innovation Division, KAGOME CO., LTD., Nagoya, Japan
| | - Mai Matsumoto
- Nature & Wellness Research Department, Innovation Division, KAGOME CO., LTD., Nagoya, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tatsuya Mikami
- Innovation Center for Health Promotion, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ken Itoh
- Department of Stress Response Science, Center for Advanced Medical Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
8
|
Fujita N, Momota M, Ishida M, Iwane T, Hatakeyama S, Yoneyama T, Hashimoto Y, Yoshikawa K, Yamaya K, Ohyama C. Association of oxidative stress with erectile dysfunction in community-dwelling men and men on dialysis. Aging Male 2022; 25:193-201. [PMID: 35916472 DOI: 10.1080/13685538.2022.2103113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To investigate the association between oxidative stress and erectile dysfunction (ED) in community-dwelling men and men on dialysis. METHODS This cross-sectional study included 398 community-dwelling men and 42 men on dialysis. Oxidative stress was assessed using 8-hydroxy-2'-deoxyguanosine (8-OHdG). Univariable and multivariable logistic regression analyses were performed to evaluate the association between oxidative stress and ED. RESULTS Spearman's rank correlation test showed no significant correlation between urine 8-OHdG levels and the 5-Item International Index of Erectile Function scores in community-dwelling men (ρ = -0.005, p = 0.917) and between plasma 8-OHdG levels and the Sexual Health Inventory for Men scores in men on dialysis (ρ = 0.166, p = 0.295). In community-dwelling men, univariable and multivariable analyses revealed that urine 8-OHdG level was not significantly associated with ED (odds ratio [OR]: 1.005, 95% confidence interval [CI]: 0.884-1.144, p = 0.934; OR: 0.930, 95% CI: 0.798-1.084, p = 0.353; respectively). In men on dialysis, univariable analyses revealed that plasma 8-OHdG level was not significantly associated with severe ED (OR: 0.967, 95% CI: 0.876-1.066, p = 0.498). CONCLUSIONS Oxidative stress was not significantly associated with ED prevalence and severity in community-dwelling men and men on dialysis.
Collapse
Affiliation(s)
- Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Mizuri Ishida
- Department of Innovation Center for Health Promotion, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuro Iwane
- Department of Innovation Center for Health Promotion, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Kanemitsu Yamaya
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
9
|
Management of male sexual dysfunction after cancer treatment. Urol Oncol 2022; 40:389-394. [PMID: 32859462 DOI: 10.1016/j.urolonc.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND With an increase in the number of cancer survivors each year, male sexual dysfunction becomes an important topic for discussion between patients and providers who treat cancer. The aim of this article is to review types and mechanisms of sexual dysfunction after cancer therapy and discuss treatment options. METHODS Contemporary concepts regarding male sexual dysfunction after cancer treatment are reviewed and translated for clinical utility. FINDINGS To optimize recovery of erectile capacity after erectile dysfunction causing cancer treatments, a penile rehabilitation protocol involving phosphodiesterase inhibitors, vacuum erection device, intra corporal injections, or a combination is likely to provide some degree of clinically significant benefit. Treating hypogonadism post cancer treatment depends on the type of cancer that has been treated and patient comorbidities. Anejaculation after cancer treatments is typically not successfully or reliably treated due to the mechanism and severity of sympathetic nerve injury. Semen cryopreservation prior to cancer treatments that may injure nerve fibers essential for the ejaculatory response is highly recommended. CONCLUSION Management of post cancer treatment sexual dysfunction requires identification of this problem and referral to a specialist if necessary. There are several management options available that can greatly enhance quality of life in this often overlooked aspect of post cancer treatment care.
Collapse
|
10
|
Malekzadeh Moghani M, Langrand-Escure J, Bouleftour W, Srour A, Vallard A, Sotton S, De Laroche G, Magné N. Preservation of organs related to future sexual function during prostate stereotactic body radiotherapy: feasibility analysis through a re-optimization process. Med Dosim 2022; 47:301-305. [PMID: 35697637 DOI: 10.1016/j.meddos.2022.05.001] [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: 07/05/2021] [Revised: 04/15/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
Preserving the quality of life and sexual function of patients with a localized prostate cancer remains a challenge for physicians and a major issue for patients. The present study aimed at demonstrating the feasibility of a dosimetric preservation of the sexual organs during prostate stereotactic radiotherapy planning. Patients from a single centre were retrospectively included in the RPAH-2 trial and randomized in Arm B if they presented with either a low- or intermediate- risk prostate cancer. A 37.5Gy in 5 fractions stereotactic body radiotherapy was delivered on the prostate gland. The corpus cavernosum, penile bulb and internal pudental arteries were retrospectively delineated before a re-optimization process. During this process, RPAH-2 trial dose constraints were respected on Gross Tumor Volume (GTV), Planning Target Volume and usual organs at risk. Pre-defined dose setting delivered to corpus cavernosum, penile bulb and internal pudental arteries were collected and compared before and after the re-optimization process. Nine patients were included in the study. A decrease of the median of each investigated dose setting (except D90% for corpus cavernosum) was reported after the re-optimization for corpus cavernosum, penile bulb and internal pudental arteries. Our study demonstrated the feasibility of a dosimetric preservation of structures considered as relevant to preserve sexual function after prostate stereotactic radiotherapy.
Collapse
Affiliation(s)
- Mona Malekzadeh Moghani
- Department of Radiation Oncology, Lucien Neuwirth Cancer Centre, Saint Priest en Jarez, France; Department of Radiation Oncology, Infertility and Reproductive Health Research Center, Shahid Behesti University of Medical Sciences, Teheran, Iran
| | - Julien Langrand-Escure
- Department of Radiation Oncology, Lucien Neuwirth Cancer Centre, Saint Priest en Jarez, France
| | - Wafa Bouleftour
- Department of Research and Teaching in Oncology, Lucien Neuwirth Cancer Centre, Saint Priest en Jarez, France.
| | - Ali Srour
- Department of Radiation Oncology, Lucien Neuwirth Cancer Centre, Saint Priest en Jarez, France
| | - Alexis Vallard
- Department of Radiation Oncology, Lucien Neuwirth Cancer Centre, Saint Priest en Jarez, France
| | - Sandrine Sotton
- Department of Radiation Oncology, Lucien Neuwirth Cancer Centre, Saint Priest en Jarez, France; Department of Research and Teaching in Oncology, Lucien Neuwirth Cancer Centre, Saint Priest en Jarez, France
| | - Guy De Laroche
- Department of Radiation Oncology, Lucien Neuwirth Cancer Centre, Saint Priest en Jarez, France
| | - Nicolas Magné
- Department of Radiation Oncology, Lucien Neuwirth Cancer Centre, Saint Priest en Jarez, France; Department of Research and Teaching in Oncology, Lucien Neuwirth Cancer Centre, Saint Priest en Jarez, France; Molecular and Cellular Radiobiology Lab, CNRS UMR 5822, Institut de Physique Nucléaire de Lyon, IPNL, 69622 Lyon Medicine University, Lyon, France
| |
Collapse
|
11
|
Duun-Henriksen AK, Dehlendorff C, Røder MA, Skriver C, Pottegård A, Friis S, Brasso K, Larsen SB. Prescription rates for drugs used in treatment of benign prostatic hyperplasia and erectile dysfunction before and after prostate cancer diagnosis. Acta Oncol 2022; 61:931-938. [PMID: 35666094 DOI: 10.1080/0284186x.2022.2082886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Symptoms and treatment of benign prostatic hyperplasia (BPH) or erectile dysfunction (ED) may lead to prostate cancer workup, and patterns of prescriptions before diagnosis may affect findings of pharmacoepidemiological studies. Usage of BPH and ED drugs after diagnosis may be related to prostate cancer treatment. We investigated differences in prescription rates of BPH and ED drugs among prostate cancer patients and cancer-free comparisons and between patients with localized and non-localized disease. MATERIAL AND METHODS A nationwide register-based study, including all Danish men aged 50-85 years diagnosed with prostate cancer during 1998-2015 and an age-matched comparison cohort without cancer. We calculated rates of new and total prescriptions in 1-month intervals from 3 years before to 3 years after cancer diagnosis for drugs used to treat BPH and ED, overall and stratified by clinical stage. RESULTS We identified 54,286 men with prostate cancer and a comparison cohort of 249,645 age-matched men. The new prescription rate for BPH drugs increased for men with prostate cancer in the year before diagnosis and peaked 1 month before diagnosis with an 18-fold higher rate. Men with prostate cancer had a higher total prescription rate of BPH drugs 3 years before diagnosis, notably among men with localized disease. Before diagnosis, the new prescription rates for ED drugs were similar among men with prostate cancer and comparisons. After diagnosis, men with prostate cancer had a 7-fold higher rate of new prescriptions for ED drugs. Among men with localized disease, the total prescription rate of ED drugs increased in the months following diagnosis. CONCLUSION Differences in prescription rates suggest increased prostate cancer surveillance among men receiving BPH drugs, whereas the post-diagnostic increase in ED drugs among men with localized disease is compatible with the increased risk of ED following prostate cancer treatment.
Collapse
Affiliation(s)
- Anne Katrine Duun-Henriksen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Martin Andreas Røder
- Department of Urology, Urological Research Unit, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Skriver
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Søren Friis
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Urology, Urological Research Unit, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Signe Benzon Larsen
- Department of Urology, Urological Research Unit, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| |
Collapse
|
12
|
Gaines JM, Macdonald EJ, Smith AJ, Diefenbach MA, Paduch DA. Race and Ethnicity Have a Significant Effect on the Disclosure of Erectile Function: An Analysis of NHANES Response Patterns. Urology 2022; 167:138-143. [DOI: 10.1016/j.urology.2022.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/17/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
|
13
|
Popiołek A, Brzoszczyk B, Jarzemski P, Piskunowicz M, Jarzemski M, Borkowska A, Bieliński M. Quality of Life of Prostate Cancer Patients Undergoing Prostatectomy and Affective Temperament. Cancer Manag Res 2022; 14:1743-1755. [PMID: 35620062 PMCID: PMC9129097 DOI: 10.2147/cmar.s358054] [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: 01/12/2022] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Prostate cancer (PC) is one of the most common malignancies in men. The population of PC survivors is growing, and understanding the roles of different factors that affect quality of life (QoL) is important. We investigated the effects of affective temperament on the QoL of PC patients. Patients and Methods All subjects (n=100) underwent medical evaluation [including demographic data, medical history, physical examination, biochemical tests, and assessment of urinary incontinence (ICIQ-UI SF scale) and erectile dysfunction (ED) (IIEF-5 and subjective ED scale)] and psychological evaluation [including assessment of affective temperament using the TEMPS-A scale, depression and anxiety (using HADS), and QoL (EORTC-QLQ-C30 and EORTC-PR25)]. The relationships between individual variables were examined. Results Erection quality after treatment was associated with better QoL in most parameters. Similar strong relationships were observed between the urinary incontinence scale and QoL. Depressive, cyclothymic, irritable, and anxious temperaments were associated with decreased QoL. On the EORTC-PR25 scale, associations were observed between a depressive temperament and worse sexual function and urinary symptoms, between a cyclothymic temperament and worse urinary symptoms, and between an irritable temperament and worse sexual functioning. Multivariate analysis identified the severity of anxiety and depression symptoms measured by HADS as the most important psychological factors affecting QoL. Conclusion QoL in PC survivors depends on many factors, including age, interval since diagnosis, tumor stage, treatment, complications, and affective temperament profile. Depressive, cyclothymic, irritable, and anxious temperaments were associated with poorer QoL in selected domains, which was not observed for a hyperthymic temperament. The temperament profile of patients was associated with mood and anxiety level, which were important determinants of a poorer QoL.
Collapse
Affiliation(s)
- Alicja Popiołek
- Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
- Department of Internal Diseases, Jan Biziel University Hospital No.2 in Bydgoszcz, Bydgoszcz, Poland
| | - Bartosz Brzoszczyk
- Clinic of Urology, Jan Biziel University Hospital No. 2 in Bydgoszcz, Bydgoszcz, Poland
| | - Piotr Jarzemski
- Clinic of Urology, Jan Biziel University Hospital No. 2 in Bydgoszcz, Bydgoszcz, Poland
| | - Małgorzata Piskunowicz
- Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Marcin Jarzemski
- Clinic of Urology, Jan Biziel University Hospital No. 2 in Bydgoszcz, Bydgoszcz, Poland
| | - Alina Borkowska
- Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Maciej Bieliński
- Department of Clinical Neuropsychology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| |
Collapse
|
14
|
MR Imaging in Real Time Guiding of Therapies in Prostate Cancer. Life (Basel) 2022; 12:life12020302. [PMID: 35207589 PMCID: PMC8878909 DOI: 10.3390/life12020302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
Magnetic resonance imaging (MRI)-guided therapy for prostate cancer (PCa) aims to reduce the treatment-associated comorbidity of existing radical treatment, including radical prostatectomy and radiotherapy. Although active surveillance has been used as a conservative method to reduce overtreatment, there is a growing demand for less morbidity and personalized (focal) treatment. The development of multiparametric MRI was of real importance in improving the detection, localization and staging of PCa. Moreover, MRI has been useful for lesion targeting within the prostate, as it is used in the guidance of prostate biopsies, by means of cognitive registration, MRI-ultrasound fusion guidance or direct in-bore MRI-guidance. With regard to PCa therapies, MRI is used for precise probe placement into the lesion and to accurately monitor the treatment in real-time. Moreover, advances in MR-compatible thermal ablation allow for noninvasive real-time temperature mapping during treatment. In this review, we present an overview of the current status of MRI-guided therapies in PCa, focusing on cryoablation, focal laser ablation, high intensity focused ultrasound and transurethral ultrasound ablation. We explain the important role of MRI in the evaluation of the completeness of the ablation and during follow-up. Finally, we will discuss the challenges and future development inherent to these new technologies.
Collapse
|
15
|
Röscher P, Sathiram R, Milios JE, van Wyk JM. Mapping the prevalence and use of questionnaires to detect the neglected sexual side effects after prostate cancer treatment: a scoping review. Syst Rev 2022; 11:2. [PMID: 34980265 PMCID: PMC8722282 DOI: 10.1186/s13643-021-01865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/02/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early prostate cancer (PCa) treatment interventions may leave men with debilitating sexual side effects, especially when not diagnosed or present at initial follow-up treatment. Men are often embarrassed to disclose their sexual dysfunction. This may lead to sexual side effects related to PCa treatment remaining untreated, adding to their burden of disability. This study was conducted to map the evidence on the prevalence of neglected sexual side effects (NSSE) after radical prostatectomy (RP) surgery or radiation treatment (RT) for PCa treatment and the reported use of questionnaires to identify such side effects. METHODS This systematic scoping review's search strategy involved searching MEDLINE/PubMed, Science Direct and Google Scholar databases. Guided by eligibility criteria, two independent reviewers conducted title, abstract and full-text screening. Data from the included studies were extracted. The review team explored the implications of the findings in relation to the research question and aims of the study. The Mixed Method Appraisal Tool was used to appraise the quality of the included studies. This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. RESULTS Searches of the databases identified 1369 articles, with 23 eventually included for review. The prevalence of NSSE ranged between 0 and 78% in studies reporting on early PCa treatment of RP and RT patients. Orgasmic dysfunction (5-78%), penile curvature changes (10-15.9%) and penile length shortening (0-55%) similarly showed a low to moderate prevalence. Climacturia had low prevalence (4-5.2%) after RT and moderate prevalence (21-38%) after RP, whilst anejaculation had low to high prevalence (11-72%) after RT. No validated questionnaire was used to detect any NSSE after early PCa treatment. Studies mainly modified other questionnaires, and two studies used non-validated questionnaires to identify some NSSE. Participants in the included studies reported being inadequately informed about the possible sexual side effects of their treatment. CONCLUSION This study showed a low to a high prevalence of NSSE in men after RP and RT for early PCa treatment. Questionnaires helped detect individual NSSEs after PCa treatment but there is currently no evidence of a valid, reliable and comprehensive questionnaire to detect the NSSE collectively. SCOPING REVIEW REGISTRATION N/A.
Collapse
Affiliation(s)
- Pierre Röscher
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal., 719 Umbilo Rd, Berea, 4001, Umbilo, South Africa.
| | - Ronisha Sathiram
- Greys Hospital Pietermaritzburg, and Clinical Researcher and Professional Practice Nelson R. Mandela School of Medicine, University of KwaZulu-Natal., 719 Umbilo Rd, Berea, 4001, Umbilo, South Africa
| | - Joanne E Milios
- School of Sport Science, Exercise & Health, The University of Western Australia., Parkway Rd, 6009, Crawley, Western Australia
| | - Jacqueline M van Wyk
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal., 719 Umbilo Rd, Berea, 4001, Umbilo, South Africa
| |
Collapse
|
16
|
Yumura Y, Takeshima T, Komeya M, Kuroda S, Saito T, Karibe J. Fertility and sexual dysfunction in young male cancer survivors. Reprod Med Biol 2022; 21:e12481. [PMID: 35949642 PMCID: PMC9356720 DOI: 10.1002/rmb2.12481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Newly emerging serious post‐treatment complications among young male cancer survivors involve fertility and sexual function, preventing them from pursuing a normal family life. Methods We studied and summarized published studies that assess the relationship between cancer treatments and reduced spermatogenesis or sexual dysfunction. Main findings Infertility often occurs because of anticancer therapies that impair spermatogenesis. While some patients postremission functionally recover fertility, others experience a decreased sperm count and azoospermia. Fertility‐preserving modalities are currently being promoted worldwide to preserve spermatogenesis following cancer therapy. Patients who can ejaculate and have sperm in their semen should cryopreserve semen. However, for patients who have never ejaculated before puberty or in whom spermatogenesis has not been established, testis biopsy is performed to collect and preserve sperm or germ cells. Fertility preservation is gaining popularity and requires continuous information dissemination to oncologists and cancer treatment professionals. Furthermore, male sexual dysfunction predominantly involves erectile dysfunction and ejaculation disorder. Conclusion Although preventive and therapeutic methods for these disorders have been established within urology, patients and medical professionals in other fields remain uninformed of these advances. Therefore, dissemination of information regarding fertility preservation techniques should be accelerated.
Collapse
Affiliation(s)
- Yasushi Yumura
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
| | - Teppei Takeshima
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
| | - Mitsuru Komeya
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
| | - Shinnosuke Kuroda
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
| | - Tomoki Saito
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
| | - Jurii Karibe
- Department of Urology, Reproduction Center Yokohama City University, Medical Center Yokohama City Japan
| |
Collapse
|
17
|
Chung E. A review of regenerative therapies as penile rehabilitation in men following primary prostate cancer treatment: Evidence for erectile restoration and cavernous nerve regeneration. Asian J Urol 2021; 9:287-293. [PMID: 36035357 PMCID: PMC9399549 DOI: 10.1016/j.ajur.2021.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/23/2021] [Accepted: 09/30/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Methods Results Conclusion
Collapse
Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, QLD, Australia
- University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Macquarie University Hospital, Sydney, NSW, Australia
- AndroUrology Centre, Brisbane, QLD, Australia.
| |
Collapse
|
18
|
Domes T, Najafabadi BT, Roberts M, Campbell J, Flannigan R, Bach P, Patel P, Langille G, Krakowsky Y, Violette PD, Brock GB, Yafi FA. Canadian Urological Association guideline: Erectile dysfunction. Can Urol Assoc J 2021; 15:310-322. [PMID: 34665713 DOI: 10.5489/cuaj.7572] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Erectile dysfunction (ED) impacts the wellness and quality of life of millions of Canadians. An evaluation focused on the identification of reversible and irreversible underlying factors is recommended for patients presenting with ED. Through a shared decision-making model framework, the goal of ED treatment is to improve functional outcomes and enhance sexual satisfaction while minimizing adverse effects associated with treatment. Given that ED is assessed and treated by multiple different types of health practitioners, the purpose of this guideline is to provide the best available evidence to facilitate care delivery through a Canadian lens. After a narrative review of ED assessment and treatment for general readership, five key clinical questions relating to priority areas of ED are assessed using the GRADE and evidence-to-decision-making frameworks.
Collapse
Affiliation(s)
- Trustin Domes
- Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Borna Tadayon Najafabadi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Matthew Roberts
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Jeffrey Campbell
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Ryan Flannigan
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Phil Bach
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Premal Patel
- Division of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | | | - Yonah Krakowsky
- Division of Urology, Women's College Hospital & Sinai Health System, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Philippe D Violette
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gerald B Brock
- Professor Emeritus, Western University, London, ON, Canada
| | - Faysal A Yafi
- Department of Urology, University of California Irvine, Irvine, CA, United States
| |
Collapse
|
19
|
Chung E. Regenerative technology to restore and preserve erectile function in men following prostate cancer treatment: evidence for penile rehabilitation in the context of prostate cancer survivorship. Ther Adv Urol 2021; 13:17562872211026421. [PMID: 34434257 PMCID: PMC8381411 DOI: 10.1177/17562872211026421] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/01/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction Erectile dysfunction (ED) following prostate cancer treatment is not uncommon and penile rehabilitation is considered the standard of care in prostate cancer survivorship (PCS), where both patient and his partner desire to maintain and/or recover pre-treatment erectile function (EF). There is a clinical interest in the role of regenerative therapy to restore EF, since existing ED treatments do not always achieve adequate results. Aim To review regenerative therapies for the treatment of ED in the context of PCS. Materials and Methods A review of the existing PubMed literature on low-intensity extracorporeal shockwave therapy (LIESWT), stem cell therapy (SCT), platelet-rich plasma (PRP), gene therapy, and nerve graft/neurorrhaphy in the treatment of ED and penile rehabilitation, was undertaken. Results IESWT promotes neovascularization and neuroprotection in men with ED. While several systematic reviews and meta-analyses showed positive benefits, there is limited published clinical data in men following radical prostatectomy. Cellular-based technology such as SCT and PRP promotes cellular proliferation and the secretion of various growth factors to repair damaged tissues, especially in preclinical studies. However, longer-term clinical outcomes and concerns regarding bioethical and regulatory frameworks need to be addressed. Data on gene therapy in post-prostatectomy ED men are lacking; further clinical studies are required to investigate the optimal use of growth factors and the safest vector delivery system. Conceptually interpositional cavernous nerve grafting and penile re-innervation technique using a somatic-to-autonomic neurorrhaphy are attractive, but issues relating to surgical technique and potential for neural 'regeneration' are questionable. Conclusion In contrast to the existing treatment regime, regenerative ED technology aspires to promote endothelial revascularization and neuro-regeneration. Nevertheless, there remain considerable issues related to these regenerative technologies and techniques, with limited data on longer-term efficacy and safety records. Further research is necessary to define the role of these alternative therapies in the treatment of ED in the context of penile rehabilitation and PCS.
Collapse
Affiliation(s)
- Eric Chung
- AndroUrology Centre, Suite 3, 530 Boundary St., Brisbane, QLD 4000, Australia
| |
Collapse
|
20
|
Chung E, Mulhall J. Practical Considerations in Inflatable Penile Implant Surgery. J Sex Med 2021; 18:1320-1327. [PMID: 34247953 DOI: 10.1016/j.jsxm.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Penile prosthesis implantation remains an effective solution for men with medical-refractory erectile dysfunction (ED) following radical pelvic surgery. Despite the distortion of pelvic anatomy, a penile implant can be performed with excellent clinical outcomes provided strict patient selection, proper preoperative workup and safe surgical principles are adhered to. AIM To provide practical recommendations on inflatable penile prosthesis (IPP) implantation in patients with medical-refractory ED, with an emphasis on patient selection and counselling, preoperative workup as well as surgical considerations to minimize intraoperative complications. METHODS A Medline search on relevant English-only articles on penile prostheses and pelvic surgery was undertaken and the following terms were included in the search for articles of interest: "bladder cancer", "prostate cancer", "rectal cancer", "pelvic surgery" and "inflatable penile implant". OUTCOMES Clinical key recommendations on patient selection, preoperative workup and surgical principles. RESULTS Patients should be made aware of the mechanics of IPP and the informed consent process should outline the benefits and disadvantages of IPP surgery, alternative treatment options, cost, potential prosthetic complications and patient's expectations on clinical outcomes. Specialised diagnostic test for workup for ED is often not necessary although preoperative workup should include screening for active infection and optimising pre-existing medical comorbidities. Precautionary measures should be carried out to minimise infective complication. Corporal dilation and reservoir placement can be challenging in this group, and surgeons may require knowledge of advanced reconstructive surgical techniques when dealing with specific cases such as coexisting Peyronie's disease and continence issue. CLINICAL TRANSLATION Strict patient selection and counselling process coupled with safe surgical principles are important to achieve excellent linical outcomes and patient satisfaction rates. STRENGTHS AND LIMITATIONS This masterclass paper provides an overview of the practical considerations for men who are undergoing IPP surgery following radical pelvic surgery. Limitations include the lack of highquality data and detailed surgical description on each surgical troubleshooting steps for various prosthetic-related complications. CONCLUSION The IPP implantation can be performed efficiently and safely in patients following radical pelvic surgery. Chung E, Mulhall J. Practical Considerations in Inflatable Penile Implant Surgery. J Sex Med 2021;18:1320-1327.
Collapse
Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane QLD, Australia; Princess Alexandra Hospital, University of Queensland, Brisbane QLD, Australia; Macquarie University Hospital, Sydney, NSW, Australia.
| | | |
Collapse
|
21
|
Alcaidinho A, Nguyen DD, Delouya G, Zorn KC, Saad F, Taussky D, Liberman D. The interaction between inflammation, urinary symptoms and erectile dysfunction in early-stage prostate cancer treated with brachytherapy. Andrologia 2021; 53:e14070. [PMID: 33852165 DOI: 10.1111/and.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/12/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022] Open
Abstract
Erectile function has been shown to decline as a function of increasing peripheral blood inflammatory markers, namely the neutrophil-to-lymphocyte ratio (NLR). We evaluated if the association between NLR and erectile dysfunction (ED) applies to patients with localised prostate cancer. We included 1,282 patients who underwent brachytherapy. ED was classified before treatment according to the Terminology Criteria for Adverse Event Scale version 3.0. ED was defined as the need for the use of oral pharmacologic or mechanical assistance to have satisfactory sexual function. We found that patients with ED were older (p < .001), more likely to have hypertension (p = .002), statin use (p = .002), diabetes (p < .001) or an IPSS ≥ 8 (p < .001). On univariable logistic regression analysis, an NLR of ≥3 was statistically significantly associated with ED (OR 1.32, p = .029). But on multivariable analysis, the association between elevated NLR and ED was not statistically significant (p = .17). Significant were age (OR 1.12, p < .001), IPSS ≥ 8 (OR 1.50, p = .008), the presence of hypertension, hyperlipidemia and diabetes (OR 2.27, p < .001), and prostate volume (OR 0.99, p = .041). The NLR does appear to be a surrogate marker of chronic inflammation that causes baseline ED in patients with localised prostate cancer.
Collapse
Affiliation(s)
- Alexandre Alcaidinho
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Guila Delouya
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Kevin C Zorn
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Fred Saad
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Daniel Liberman
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
22
|
Watson E, Wilding S, Matheson L, Brett J, McCaughan E, Downing A, Wright P, Cross W, Selby P, Butcher H, Glaser A, Gavin A, Wagland R. Experiences of Support for Sexual Dysfunction in Men With Prostate Cancer: Findings From a U.K.-Wide Mixed Methods Study. J Sex Med 2021; 18:515-525. [PMID: 33642238 DOI: 10.1016/j.jsxm.2020.12.017] [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: 02/03/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Men with prostate cancer (PCa) often experience sexual dysfunction following diagnosis and treatment, yet little is known about the support they receive to deal with this. AIM To explore men's experiences of support for sexual dysfunction following PCa diagnosis. METHODS This study included a U.K.-wide survey of men 18-42 months post-diagnosis of PCa, identified through cancer registries. The survey measured sexual function and the extent to which men perceived sexual dysfunction to be a problem (Expanded Prostate Cancer Index Composite-26), access to and experience of medications, devices, and specialist services for sexual dysfunction, and included a free-text question for further comments. Analysis focussed on men who reported poor sexual function, which they considered a moderate or big problem. Descriptive statistics explored the characteristics of men offered intervention and those that found this helpful. Free-text responses were analyzed using thematic analysis. OUTCOME The main outcome of this study was to assess access to and experience of medications, devices, and specialist services for sexual dysfunction. RESULTS 39.0% of all survey respondents (13,978/35,823) reported poor sexual function, which they considered a moderate or big problem. 51.7% of these men were not offered any intervention to aid sexual functioning. 71.9% of those offered an intervention reported trying it, of whom 48.7% found the intervention helpful. Men treated with surgery or brachytherapy were most likely to be offered an intervention. Medication was the most commonly offered intervention and 39.3% of those who tried medication found this helpful. Although offered less often, approximately half of the men who tried devices or attended specialist services found the intervention helpful. Free-text responses indicated that barriers to accessing support included inadequate information and support from healthcare professionals, embarrassment, negative views about treatment options, concerns about side effects and safety, and inconsistencies between secondary and primary care. Barriers to continuing use included limited effectiveness of treatments, inadequate ongoing support, and funding constraints. Drivers of sexual recovery included patient proactivity and persistence with trying different treatment options and ongoing support from health professionals. CLINICAL IMPLICATIONS There is an urgent need to ensure that all men are offered, and have equal access to, sexual care support, with referral to specialist services when required. STRENGTHS & LIMITATIONS This study presents data from a large, U.K.-wide, population-based study of men with PCa and includes quantitative and qualitative findings. The possibility of non-response bias should, however, be considered. CONCLUSION There are significant shortcomings in the support offered to U.K. men with sexual dysfunction following diagnosis and treatment for PCa which need to be addressed. Watson E, Wilding S, Matheson L, et al. Experiences of Support for Sexual Dysfunction in Men With Prostate Cancer: Findings From a U.K.-Wide Mixed Methods Study. J Sex Med 2021;18:515-525.
Collapse
Affiliation(s)
- Eila Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK.
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; School of Psychology, University of Leeds, Leeds, UK
| | - Lauren Matheson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Jo Brett
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Eilis McCaughan
- Institute of Nursing and Health Research, Ulster University, Coleraine, N.Ireland, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | | | - Peter Selby
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Adam Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University, Belfast, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
23
|
McCaughan E, Flannagan C, Parahoo K, Connaghan J, Maguire R, Steele M, Thompson S, Jain S, Kirby M, Brady N, O'Connor SR. The Tablet-Based, Engagement, Assessment, Support, and Sign-Posting (EASSi) Tool for Facilitating and Structuring Sexual Well-Being Conversations in Routine Prostate Cancer Care: Mixed-Methods Study. JMIR Cancer 2020; 6:e20137. [PMID: 33275109 PMCID: PMC7748949 DOI: 10.2196/20137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 12/14/2022] Open
Abstract
Background Long-term side-effects associated with different prostate cancer treatment approaches are common. Sexual challenges are the most frequently occurring issues and can result in increased psychological morbidity. It is recognized that barriers to communication can make initiating discussions around sexual concerns in routine practice difficult. Health care professionals need to routinely initiate conversations, effectively engage with patients, and assess needs in order to provide essential support. One proposed method that could support health care professionals to do this involves the use of prompts or structured frameworks to guide conversations. Objective This study aimed to assess feasibility, acceptability, and satisfaction with the tablet-based Engagement, Assessment, Support, and Sign-posting (EASSi) tool designed to facilitate and structure sexual well-being discussions in routine prostate cancer care. Methods Health care professionals (n=8) used the EASSi tool during 89 posttreatment appointments. Quantitative data were recorded based on program usage and surveys completed by health care professionals and patients. Qualitative data exploring perceptions on use of the tool were gathered using semistructured interviews with all health care professionals (n=8) and a sample of patients (n=10). Results Surveys were completed by health care professionals immediately following each appointment (n=89, 100%). Postal surveys were returned by 59 patients (66%). Health care professionals and patients reported that the tool helped facilitate discussions (81/89, 91% and 50/59, 85%, respectively) and that information provided was relevant (82/89, 92% and 50/59, 85%, respectively). The mean conversation duration was 6.01 minutes (SD 2.91). Qualitative synthesis identified the tool’s ability to initiate and structure discussions, improve the “depth” of conversations, and normalize sexual concerns. Conclusions The EASSi tool was appropriate and acceptable for use in practice and provided a flexible approach to facilitate routine brief conversations and deliver essential sexual well-being support. Further work will be conducted to evaluate the effectiveness of using the tablet-based tool in prostate cancer care settings.
Collapse
Affiliation(s)
- Eilís McCaughan
- Institute of Nursing & Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Carrie Flannagan
- Institute of Nursing & Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Kader Parahoo
- Institute of Nursing & Health Research, Ulster University, Newtownabbey, United Kingdom
| | - John Connaghan
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Roma Maguire
- Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Mary Steele
- Faculty of Social and Human Sciences, Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | | | - Suneil Jain
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom.,Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, United Kingdom
| | - Michael Kirby
- Faculty of Health and Human Sciences, University of Hertfordshire, Hatfield, United Kingdom.,The Prostate Centre, London, United Kingdom
| | - Nuala Brady
- Northern Heath and Social Care Trust, Antrim, United Kingdom
| | - Seán R O'Connor
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, United Kingdom
| |
Collapse
|
24
|
Röscher P, van Wyk JM. Mapping the prevalence of the neglected sexual side effects after prostate cancer treatment and the questionnaires used in their screening: a scoping review protocol. Syst Rev 2020; 9:214. [PMID: 32938488 PMCID: PMC7495715 DOI: 10.1186/s13643-020-01473-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/02/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Interventions to treat early prostate cancer (PCa) can leave men with debilitating sexual side effects. The cluster of side effects referred to as the neglected sexual side effects (NSSE) may remain permanent, undiagnosed and untreated because men are hesitant to disclose them. Questionnaires offer a discreet way into the discussion, subsequent diagnosis and possible treatment of the NSSE. This study will be conducted to map the evidence about the prevalence of the neglected sexual side effects (NSSE) after PCa treatment, and use of questionnaires in its diagnosis and screening. METHODS This systematic scoping review will involve searching the following electronic databases: PubMed, Science Direct and Google Scholar. Following title searching, two-independent reviewers will conduct screening of abstracts and full articles. Eligibility criteria will guide the screenings. Data will be extracted from the included studies, and the emerging themes will be analysed. The review team will analyse the implications of the findings concerning the research question and aim of the study. The mixed method appraisal tool (MMAT) will be employed for quality appraisal of included studies. DISCUSSION We anticipate finding a number of studies that describe the prevalence of NSSE after early PCa treatment and that report on using questionnaires to screen for the presence of symptoms including orgasm-associated incontinence, urinary incontinence during sexual stimulation, altered perceptions of orgasm, orgasm associated pain, penile shortening and penile deformity. The study findings will be disseminated through publication in a peer-reviewed journal, peer presentations and presentations at relevant conferences.
Collapse
Affiliation(s)
- Pierre Röscher
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Rd, Umbilo, Berea, 4001, South Africa.
| | - Jacqueline M van Wyk
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Rd, Umbilo, Berea, 4001, South Africa
| |
Collapse
|
25
|
Shigeta K, Kikuchi E, Matsushima M, Ogihara K, Kosaka T, Mizuno R, Tanaka T, Shigematsu N, Oya M. Relationship between radiation doses and erectile function deterioration in patients with localized prostate cancer treated with permanent prostate brachytherapy. Int J Urol 2020; 27:1087-1093. [PMID: 32893378 DOI: 10.1111/iju.14358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the relationship between radiation doses in prostate brachytherapy and deterioration of erectile function in patients with localized prostate cancer. METHODS A longitudinal survey study was carried out among 261 prostate cancer patients who received prostate brachytherapy. A total of 48 patients were potent at baseline and they did not receive any supplemental therapy preoperatively. Dosimetry parameters of the whole prostate gland, prostate apex, urethra and rectum were collected using the VariSeed 8.0 treatment planning system (Varian Medical Systems, Palo Alto, CA, USA). We carried out a logistic regression analysis to clarify the relationship between radiation doses and erectile function deterioration, which was assessed using the International Index of Erectile Function-15 questionnaire. RESULTS The median patient age was 66 years (range 53-70 years) with a median follow-up time of 44 months (36-71 months). The mean total International Index of Erectile Function-15 score decreased from 49.9 at baseline to 34.7 after 12 months (P < 0.001), but gradually plateaued within 36 months. Erectile function deterioration was noted in 32 (66.7%) patients 36 months after prostate brachytherapy. In an analysis of risk factors for erectile function deterioration after prostate brachytherapy, age ≥70 years (P = 0.029), prostate V100 ≥95% (P = 0.024), apex V100 ≥95% (P = 0.024), apex V150 ≥70% (P = 0.009) and apex D90 ≥150 Gy (P = 0.011) correlated with erectile function deterioration. A multivariate analysis identified an age of ≥70 years (odds ratio 7.91, P = 0.024) and apex V150 ≥70% (odds ratio 7.75, P = 0.007) as independent risk factors for erectile function deterioration after prostate brachytherapy. CONCLUSIONS An excessive radiation dose, particularly to the prostate apex area, and an advanced age might have a negative impact on the preservation of potency after prostate brachytherapy.
Collapse
Affiliation(s)
- Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.,Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Koichiro Ogihara
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Tomoki Tanaka
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Naoyuki Shigematsu
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
26
|
Philippou Y, Sjoberg HT, Murphy E, Alyacoubi S, Jones KI, Gordon-Weeks AN, Phyu S, Parkes EE, Gillies McKenna W, Lamb AD, Gileadi U, Cerundolo V, Scheiblin DA, Lockett SJ, Wink DA, Mills IG, Hamdy FC, Muschel RJ, Bryant RJ. Impacts of combining anti-PD-L1 immunotherapy and radiotherapy on the tumour immune microenvironment in a murine prostate cancer model. Br J Cancer 2020; 123:1089-1100. [PMID: 32641865 PMCID: PMC7525450 DOI: 10.1038/s41416-020-0956-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Radiotherapy enhances innate and adaptive anti-tumour immunity. It is unclear whether this effect may be harnessed by combining immunotherapy with radiotherapy fractions used to treat prostate cancer. We investigated tumour immune microenvironment responses of pre-clinical prostate cancer models to radiotherapy. Having defined this landscape, we tested whether radiotherapy-induced tumour growth delay could be enhanced with anti-PD-L1. METHODS Hypofractionated radiotherapy was delivered to TRAMP-C1 and MyC-CaP flank allografts. Tumour growth delay, tumour immune microenvironment flow-cytometry, and immune gene expression were analysed. TRAMP-C1 allografts were then treated with 3 × 5 Gy ± anti-PD-L1. RESULTS 3 × 5 Gy caused tumour growth delay in TRAMP-C1 and MyC-CaP. Tumour immune microenvironment changes in TRAMP-C1 at 7 days post-radiotherapy included increased tumour-associated macrophages and dendritic cells and upregulation of PD-1/PD-L1, CD8+ T-cell, dendritic cell, and regulatory T-cell genes. At tumour regrowth post-3 × 5 Gy the tumour immune microenvironment flow-cytometry was similar to control tumours, however CD8+, natural killer and dendritic cell gene transcripts were reduced. PD-L1 inhibition plus 3 × 5 Gy in TRAMP-C1 did not enhance tumour growth delay versus monotherapy. CONCLUSION 3 × 5 Gy hypofractionated radiotherapy can result in tumour growth delay and immune cell changes in allograft prostate cancer models. Adjuncts beyond immunomodulation may be necessary to improve the radiotherapy-induced anti-tumour response.
Collapse
Affiliation(s)
| | - Hanna T Sjoberg
- Department of Oncology, University of Oxford, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Emma Murphy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Said Alyacoubi
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Keaton I Jones
- Department of Oncology, University of Oxford, Oxford, UK
| | | | - Su Phyu
- Department of Oncology, University of Oxford, Oxford, UK
| | | | | | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Uzi Gileadi
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Vincenzo Cerundolo
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - David A Scheiblin
- Optical Microscopy and Analysis Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc. for the National Cancer Institute, National Institutes of Health, Frederick, 21702, MD, USA
| | - Stephen J Lockett
- Optical Microscopy and Analysis Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc. for the National Cancer Institute, National Institutes of Health, Frederick, 21702, MD, USA
| | - David A Wink
- Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, 21702, MD, USA
| | - Ian G Mills
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Ruth J Muschel
- Department of Oncology, University of Oxford, Oxford, UK
| | - Richard J Bryant
- Department of Oncology, University of Oxford, Oxford, UK.
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
| |
Collapse
|
27
|
Philippou Y, Sjoberg H, Lamb AD, Camilleri P, Bryant RJ. Harnessing the potential of multimodal radiotherapy in prostate cancer. Nat Rev Urol 2020; 17:321-338. [PMID: 32358562 DOI: 10.1038/s41585-020-0310-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2020] [Indexed: 12/11/2022]
Abstract
Radiotherapy in combination with androgen deprivation therapy (ADT) is a standard treatment option for men with localized and locally advanced prostate cancer. However, emerging clinical evidence suggests that radiotherapy can be incorporated into multimodality therapy regimens beyond ADT, in combinations that include chemotherapy, radiosensitizing agents, immunotherapy and surgery for the treatment of men with localized and locally advanced prostate cancer, and those with oligometastatic disease, in whom the low metastatic burden in particular might be treatable with these combinations. This multimodal approach is increasingly recognized as offering considerable clinical benefit, such as increased antitumour effects and improved survival. Thus, radiotherapy is becoming a key component of multimodal therapy for many stages of prostate cancer, particularly oligometastatic disease.
Collapse
Affiliation(s)
- Yiannis Philippou
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Headington, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Headington, Oxford, UK
| | - Hanna Sjoberg
- Nuffield Department of Surgical Sciences, University of Oxford, Headington, Oxford, UK
| | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Headington, Oxford, UK
| | - Philip Camilleri
- Oxford Department of Clinical Oncology, Churchill Hospital Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, UK
| | - Richard J Bryant
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Headington, Oxford, UK.
- Nuffield Department of Surgical Sciences, University of Oxford, Headington, Oxford, UK.
| |
Collapse
|
28
|
McCaughan E, Parahoo K, Flannagan C, Maguire R, Connaghan J, Steele M, Thompson S, Jain S, Kirby M, Brady N, O'Connor SR. Development of a conceptual framework to improve sexual wellbeing communication in routine prostate cancer care. PATIENT EDUCATION AND COUNSELING 2020; 103:1150-1160. [PMID: 32029296 DOI: 10.1016/j.pec.2020.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/31/2019] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To systematically develop a framework to improve sexual wellbeing communication in routine prostate cancer care. METHODS The Theoretical Domains Framework was used to guide a multi-phase process used to identify components of the framework based on evidence reviews, semi-structured interviews and stakeholder workshops. 'Think-aloud' testing was used to explore usability, potential barriers and other factors relevant to implementation. RESULTS A conceptual communication framework consisting of 'Engagement' (E), 'Assessment' (A), information and 'Support' (S) and 'Sign-posting' (Si) sections was developed. The framework emphasises routine engagement to normalise sexual concerns, brief, non-sensitive assessment, personalised advice based on treatment type and relationship status, and a mechanism for referral to additional support or self-management resources in the form of a patient and partner handout. Usability testing identified strategies to promote implementation. CONCLUSIONS The proposed framework is appropriate for use in routine practice and appears to be acceptable to patients, partners and healthcare professionals. Its use may help address gaps in sexual wellbeing support for men and partners living with prostate cancer. Further work will be conducted evaluating an online engagement tool, modelled on the framework. PRACTICE IMPLICATIONS The EASSi framework can facilitate and structure sexual wellbeing conversations and ensure fundamental but individualised support is provided routinely in prostate cancer care.
Collapse
Affiliation(s)
- Eilís McCaughan
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK.
| | - Kader Parahoo
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Carrie Flannagan
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - John Connaghan
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Mary Steele
- Centre for Clinical and Community Applications of Health Psychology, Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Samantha Thompson
- Urology Department, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Suneil Jain
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK; Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Mike Kirby
- Faculty of Health and Human Sciences, University of Hertfordshire and The Prostate Centre, London, UK
| | - Nuala Brady
- Northern Health and Social Care Trust, Northern Ireland, UK
| | - Seán R O'Connor
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK; Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| |
Collapse
|
29
|
Dilalla V, Chaput G, Williams T, Sultanem K. Radiotherapy side effects: integrating a survivorship clinical lens to better serve patients. Curr Oncol 2020; 27:107-112. [PMID: 32489253 PMCID: PMC7253739 DOI: 10.3747/co.27.6233] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The Canadian Cancer Society estimated that 220,400 new cases of cancer would be diagnosed in 2019. Of the affected patients, more than 60% will survive for 5 years or longer after their cancer diagnosis. Furthermore, nearly 40% will receive at least 1 course of radiotherapy (rt). Radiotherapy is used with both curative and palliative intent: to treat early-stage or locally advanced tumours (curative) and for symptom management in advanced disease (palliative). It can be delivered systemically (external-beam rt) or internally (brachytherapy). Although technique improvements have drastically reduced the occurrence of rt-related toxicity, most patients still experience burdensome rt side effects (seffs). Radiotherapy seffs are local or locoregional, and manifest in tissues or organs that were irradiated. Side effects manifesting within weeks after rt completion are termed "early seffs," and those occurring months or years after treatment are termed "late seffs." In addition to radiation oncologists, general practitioners in oncology and primary care providers are involved in survivorship care and management of rt seffs. Here, we present an overview of common seffs and their respective management: anxiety, depression, fatigue, and effects related to the head-and-neck, thoracic, and pelvic treatment sites.
Collapse
Affiliation(s)
- V Dilalla
- Division of Radiation Oncology, McGill University, Montreal, QC
| | - G Chaput
- Department of Family Medicine (Secondary Care), Division of Supportive and Palliative Medicine, McGill University Health Centre, and McGill University, Montreal, QC
| | - T Williams
- Cancer Care Mission Patients' Committee, McGill University Health Centre, Montreal, QC
| | - K Sultanem
- Department of Oncology, Division of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| |
Collapse
|
30
|
Discovery of Novel Inhibitors Targeting Multi-UDP-hexose Pyrophosphorylases as Anticancer Agents. Molecules 2020; 25:molecules25030645. [PMID: 32028604 PMCID: PMC7038226 DOI: 10.3390/molecules25030645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 02/06/2023] Open
Abstract
To minimize treatment toxicities, recent anti-cancer research efforts have switched from broad-based chemotherapy to targeted therapy, and emerging data show that altered cellular metabolism in cancerous cells can be exploited as new venues for targeted intervention. In this study, we focused on, among the altered metabolic processes in cancerous cells, altered glycosylation due to its documented roles in cancer tumorigenesis, metastasis and drug resistance. We hypothesize that the enzymes required for the biosynthesis of UDP-hexoses, glycosyl donors for glycan synthesis, could serve as therapeutic targets for cancers. Through structure-based virtual screening and kinetic assay, we identified a drug-like chemical fragment, GAL-012, that inhibit a small family of UDP-hexose pyrophosphorylases-galactose pyro-phosphorylase (GALT), UDP-glucose pyrophosphorylase (UGP2) and UDP-N-acetylglucosamine pyrophosphorylase (AGX1/UAP1) with an IC50 of 30 µM. The computational docking studies supported the interaction of GAL-012 to the binding sites of GALT at Trp190 and Ser192, UGP2 at Gly116 and Lys127, and AGX1/UAP1 at Asn327 and Lys407, respectively. One of GAL-012 derivatives GAL-012-2 also demonstrated the inhibitory activity against GALT and UGP2. Moreover, we showed that GAL-012 suppressed the growth of PC3 cells in a dose-dependent manner with an EC50 of 75 µM with no effects on normal skin fibroblasts at 200 µM. Western blot analysis revealed reduced expression of pAKT (Ser473), pAKT (Thr308) by 77% and 72%, respectively in the treated cells. siRNA experiments against the respective genes encoding the pyrophosphorylases were also performed and the results further validated the proposed roles in cancer growth inhibition. Finally, synergistic relationships between GAL-012 and tunicamycin, as well as bortezomib (BTZ) in killing cultured cancer cells were observed, respectively. With its unique scaffold and relatively small size, GAL-012 serves as a promising early chemotype for optimization to become a safe, effective, multi-target anti-cancer drug candidate which could be used alone or in combination with known therapeutics.
Collapse
|
31
|
Rasmusson E, Gunnlaugsson A, Wieslander E, Höglund P, Widmark A, Fransson P, Kjellén E, Nilsson P. Erectile Dysfunction and Absorbed Dose to Penile Base Structures in a Randomized Trial Comparing Ultrahypofractionated and Conventionally Fractionated Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2020; 107:143-151. [PMID: 32004582 DOI: 10.1016/j.ijrobp.2020.01.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To study the relationships between absorbed dose to penile base structures and erectile dysfunction (ED) in patients treated with ultrahypofractionated (UHF) radiation therapy (RT) or conventionally fractionated (CF) RT for prostate cancer. METHODS AND MATERIALS This dose-response study comprises 673 patients (57%) of the 1180 per-protocol patients included in the HYPO-RT-PC trial (median follow-up 5, years), where patients were randomized to CF (39 × 2.0 Gy, 8 weeks) or UHF (7 × 6.1 Gy, 2.5 weeks). No androgen deprivation therapy was allowed. Only patients with erectile function sufficient for intercourse at baseline and complete RT data were included in this study. Erectile function was assessed by physician at regular follow-ups. The main endpoint was severe ED (EDs). The penile bulb (PB) and crus were retrospectively delineated on the treatment planning computed tomography scans. Dose-volume descriptors were derived from EQD2 converted dose matrices (α/β = 3 Gy). Univariable and multivariable Cox proportional hazard regression and logistic regression were used to find predictors for EDS. RESULTS No significant difference in EDs was found between CF and UHF. During the follow-up period, EDs occurred in 27% of the patients in both treatment groups. Average (median) PB mean dose, Dmean, was 24.5 (20.2) in CF and 18.7 (13.1) Gy3 in UHF. Age was the only significant predictor for EDs in Cox analyses. All dose-volume variables contributed significantly in univariable logistic regression at 2-year follow-up. Age and near maximum dose (D2%) were significant predictors for EDs in multivariable logistic regression analyses at both 1 and 2 years. CONCLUSIONS The frequency of EDS was similar in the CF and UHF treatment groups. Age at radiation therapy was the strongest predictor for EDs, followed by dose to PB, and was most evident for younger patients. We propose D2 % <50 Gy3 and Dmean <20 Gy3 to the PB as the primary objectives to be applied in the treatment planning process.
Collapse
Affiliation(s)
- Elisabeth Rasmusson
- Department of Haematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden; Department of Clinical Sciences, Faculty of Medicine, Oncology and Pathology, Lund University, Lund, Sweden.
| | - Adalsteinn Gunnlaugsson
- Department of Haematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden; Department of Clinical Sciences, Faculty of Medicine, Oncology and Pathology, Lund University, Lund, Sweden
| | - Elinore Wieslander
- Department of Haematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Peter Höglund
- Department of Laboratory Medicine, Faculty of Medicine, Clinical Pharmacology, Lund University, Lund, Sweden
| | - Anders Widmark
- Department of Oncology, Umeå University Hospital, Umeå, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University Umeå, Sweden
| | - Elisabeth Kjellén
- Department of Haematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden; Department of Clinical Sciences, Faculty of Medicine, Oncology and Pathology, Lund University, Lund, Sweden
| | - Per Nilsson
- Department of Haematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden; Department of Clinical Sciences, Faculty of Medicine, Radiation Physics, Lund University, Lund, Sweden
| |
Collapse
|
32
|
Abstract
OBJECTIVE To review the sexual health issues cancer survivors may experience, including incidence, association with treatment modalities, and approach to evaluation and treatment. DATA SOURCES Peer-reviewed journal articles, medical society or government Web sites. CONCLUSION Cancer diagnosis and treatment often impacts sexual function and addressing this is a key component of health-related quality of life. IMPLICATIONS FOR NURSING PRACTICE Screening, evaluation, and treatment of sexual dysfunction should be incorporated into routine oncologic care.
Collapse
|
33
|
Cooper SA, Compton PA. Nursing interventions for sexual dysfunction: An integrative review for the psychiatric nurse. Arch Psychiatr Nurs 2019; 33:389-399. [PMID: 31280785 DOI: 10.1016/j.apnu.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/13/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022]
Abstract
Sexual dysfunctions are prevalent disorders in psychiatric patients that too often are not addressed by psychiatric-mental health nurses. An integrative review was conducted using PubMed, Joanna Briggs Institute, SCOPUS, PsycINFO and CINAHL databases to evaluate the evidence for independent, nursing interventions for sexual dysfunction across all nursing literature that could be implemented by psychiatric-mental health nurses. Out of 2448 articles, nine papers met inclusion criteria and were synthesized. Best available evidence was found for sexual teaching interventions for female sexual dysfunction. The implications for psychiatric-mental health nursing practice and recommendations for future research are discussed.
Collapse
Affiliation(s)
- Shane A Cooper
- The University of Pennsylvania, School of Nursing, 418 Curie Blvd, Room 402, Philadelphia, PA 19104, United States of America.
| | - Peggy A Compton
- The University of Pennsylvania, School of Nursing, 418 Curie Blvd, Room 402, Philadelphia, PA 19104, United States of America.
| |
Collapse
|
34
|
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.
Collapse
|
35
|
Greenstein A, Dekalo S, Chen J. Penile size in adult men—recommendations for clinical and research measurements. Int J Impot Res 2019; 32:153-158. [DOI: 10.1038/s41443-019-0157-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 03/28/2019] [Accepted: 04/23/2019] [Indexed: 11/09/2022]
|
36
|
Gebauer J, Higham C, Langer T, Denzer C, Brabant G. Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review. Endocr Rev 2019; 40:711-767. [PMID: 30476004 DOI: 10.1210/er.2018-00092] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
The number of patients surviving ≥5 years after initial cancer diagnosis has significantly increased during the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is that the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified, including radiation, sex, and age at the time of diagnosis. A systematic literature search has been conducted using the PubMed database to offer a detailed overview of the spectrum of late endocrine disorders following oncological treatment. Most data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult-onset cancer survivors is much less clear. Endocrine sequelae of cancer therapy include functional alterations in hypothalamic-pituitary, thyroid, parathyroid, adrenal, and gonadal regulation as well as bone and metabolic complications. Surgery, radiotherapy, chemotherapy, and immunotherapy all contribute to these sequelae. Following irradiation, endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.
Collapse
Affiliation(s)
- Judith Gebauer
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom.,Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Thorsten Langer
- Division of Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christian Denzer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Ulm University Medical Center, Ulm, Germany
| | - Georg Brabant
- Experimental and Clinical Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
37
|
Ciabatti S, Ntreta M, Buwenge M, Gaudiano C, Sessagesimi E, Romani F, Angelini AL, Cammelli S, Macchia G, Deodato F, Zamagni A, Golfieri R, Morganti AG, Cilla S. Dominant intraprostatic lesion boosting in sexual-sparing radiotherapy of prostate cancer: A planning feasibility study. Med Dosim 2019; 44:356-364. [PMID: 30955990 DOI: 10.1016/j.meddos.2019.01.008] [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: 09/01/2018] [Revised: 12/30/2018] [Accepted: 01/22/2019] [Indexed: 02/07/2023]
Abstract
AIM Radical radiotherapy of prostate cancer requires a relatively high dose to achieve an optimal tumor control probability and a reduced dose to the critical structures related to the sexual function (S_OARs) in order to avoid erectile dysfunction. The aim of this study was to perform a planning feasibility analysis of a 3-level dose prescription with Simultaneous Integrated Boost (SIB) on the dominant intraprostatic lesion (DIL) and with S_OARs sparing. MATERIAL AND METHODS Twelve patients with clinically localized intermediate risk prostate cancer were included. The prostate, seminal vescicles, and DIL Clinical Target Volumes were delineated on rigid fused MRI-CT simulation images using mp-MRI as a separate guide. A 5 mm margin was added to define the PTVs. Penile bulb (PB), corpora cavernosa (CC), internal pudendal arteries (IPAs) and neurovascular bundles were contoured as S_OARs. The following doses were prescribed in 25 fractions: 56.25 Gy to PTVsv, 67.50 Gy to PTVp, and 75 Gy to PTVdil. Standard plans (SD-VMAT) were created to fulfil targets coverage and Quantec constraints for conventional OARs (SD_OARs: rectum, bladder, and femoral heads). For each patient, a new "sexual-sparing" plan (SS-VMAT) was created adding new objectives for S_OARs with priority to minimize mean doses to IPAs, CC, and PB. Dose-volume histogram end points were compared between the 2 plans using Wilcoxon test. RESULTS D98% were >95% of prescribed doses for all targets and techniques. No significant differences were found in sparing SD_OARs for considered metrics. Regarding S_OARs, SS_VMAT plans provided a significant reduction of the dose. Mean dose reduction for IPAs, CC, PB, and neurovascular bundles was 32.4% (11.2 Gy, p = 0.002), 22.5% (4.1 Gy, p = 0.006), 10.0% (4.6 Gy, p = 0.010), and 2.6% (1.8 Gy, p = 0.020), respectively. CONCLUSIONS We showed that a significant dose sparing for S_OARs using VMAT-SIB strategy is feasible allowing "sexual-sparing" and highly conformal plans with dose escalation to the DIL.
Collapse
Affiliation(s)
- Selena Ciabatti
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Ntreta
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Caterina Gaudiano
- Radiology Unit, Department of Diagnostic Medicine and Prevention, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elisa Sessagesimi
- Radiology Unit, Department of Diagnostic Medicine and Prevention, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabrizio Romani
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Anna L Angelini
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Alice Zamagni
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Diagnostic Medicine and Prevention, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| |
Collapse
|
38
|
Ashcraft KA, Hannan JL, Eichenbaum G, Zhang X, Pak ES, Faught AM, Patel P, Dewhirst MW, Koontz BF. Clarifying the Relative Impacts of Vascular and Nerve Injury That Culminate in Erectile Dysfunction in a Pilot Study Using a Rat Model of Prostate Irradiation and a Thrombopoietin Mimetic. Int J Radiat Oncol Biol Phys 2018; 103:1212-1220. [PMID: 30529374 DOI: 10.1016/j.ijrobp.2018.11.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Radiation therapy (RT) offers an important and curative approach to treating prostate cancer, but it is associated with a high incidence of erectile dysfunction (ED). It is not clear whether the etiology of radiation-induced ED (RI-ED) is driven by RT-mediated injury to the vasculature, the nerves, or both. This pilot study sought to distinguish the effects of vascular and nerve injury in RI-ED by applying a vascular radioprotectant in a rat model of prostate RT. METHODS A single dose of the thrombopoietin mimetic (TPOm; RWJ-800088), previously shown to mitigate radiation-induced vascular injury, was administered 10 minutes after single-fraction conformal prostate RT. Nine weeks after RT, rats were assessed for erectile and arterial function. Nerve markers were quantified with reverse transcriptase polymerase chain reaction. Immunofluorescent microscopy further characterized vascular effects of RT and TPOm. RESULTS Sham animals and animals that received RT and TPOm showed significant arterial vasodilation in response to systemic hydralazine (24.1% ± 7.3% increase; P = .03 in paired t test). However, animals that received RT and vehicle were unable to mount a vasodilatory response (-7.4% ± 9.9% increase; P = .44 in paired t test). TPOm prevented RT-induced change in the penile artery cross-sectional area (P = .036), but it did not ameliorate cavernous nerve injury as evaluated by gene expression of neuronal injury markers. Despite significant structural and functional vascular protective effects and some trends for differences in nerve injury/recovery markers, TPOm did not prevent RI-ED at 9 weeks, as assessed by intracavernous pressure monitoring after cavernous nerve stimulation. CONCLUSIONS These data suggest that vascular protection alone is not sufficient to prevent RI-ED and that cavernous nerve injury plays a key role in RI-ED. Further research is required to delineate the multifactorial nature of RI-ED and to determine if TPOm with modified dosing regimens can mitigate against nerve injury either through direct or vascular protective effects.
Collapse
Affiliation(s)
- Kathleen A Ashcraft
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina
| | - Johanna L Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Gary Eichenbaum
- Johnson & Johnson, Office of the Chief Medical Officer, New Brunswick, New Jersey
| | - Xiaojie Zhang
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina
| | - Elena S Pak
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Austin M Faught
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina
| | - Pranalee Patel
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina
| | - Mark W Dewhirst
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina
| | - Bridget F Koontz
- Duke University School of Medicine, Department of Radiation Oncology, Durham, North Carolina.
| |
Collapse
|
39
|
Garcia-Baquero R, Fernandez-Avila CM, Alvarez-Ossorio JL. Functional results in the treatment of localized prostate cancer. An updated literature review. Rev Int Androl 2018; 17:143-154. [PMID: 30473332 DOI: 10.1016/j.androl.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/02/2018] [Accepted: 06/12/2018] [Indexed: 01/22/2023]
Abstract
Prostate cancer is the second most frequently diagnosed cancer in men. The initial diagnosis is made in increasingly younger patients, so it seems to be essential to guarantee optimal functional results. We carried out a systematic search to define the functional results of each of the therapeutic options for localized prostate cancer. Radical prostatectomy generates a greater negative effect on urinary continence and erectile function compared to active surveillance and radiotherapy. Robotic surgery seems to offer better functional results, especially at the level of erectile function. Urinary and bowel symptoms are more pronounced after radiotherapy compared to other options. Patients must be warned of the possible functional results prior to choice of treatment.
Collapse
Affiliation(s)
- Rodrigo Garcia-Baquero
- Andrology and Reconstructive Surgery Unit, Urology Department, Hospital Universitario Puerta del Mar [Puerta del Mar University Hospital], Cadiz, Spain.
| | - Cristina Margarita Fernandez-Avila
- Andrology and Reconstructive Surgery Unit, Urology Department, Hospital Universitario Puerta del Mar [Puerta del Mar University Hospital], Cadiz, Spain
| | - José Luis Alvarez-Ossorio
- Andrology and Reconstructive Surgery Unit, Urology Department, Hospital Universitario Puerta del Mar [Puerta del Mar University Hospital], Cadiz, Spain
| |
Collapse
|
40
|
Nakai Y, Tanaka N, Anai S, Miyake M, Asakawa I, Morizawa Y, Hori S, Torimoto K, Fujii T, Hasegawa M, Fujimoto K. Quality of life worsened the most severely in patients immediately after intensity-modulated radiotherapy for prostate cancer. Res Rep Urol 2018; 10:169-180. [PMID: 30425973 PMCID: PMC6203165 DOI: 10.2147/rru.s168651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose The aim of this study was to evaluate the chronological changes in lower urinary tract symptoms (LUTSs), disease-related quality of life (QOL), and health-related QOL (HR-QOL) of patients who received intensity-modulated radiotherapy (IMRT). Patients and methods In 121 patients who had received IMRT and were followed up for >2 years, the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Expanded Prostate Cancer Index Composite (EPIC), and 8-Item Short-Form Health Survey (SF-8) were used before IMRT, at the halfway point in IMRT, immediately after IMRT, and 1–24 months after the completion of IMRT. Results The IPSS and OABSS and the urinary and bowel domains of the EPIC indicated that QOL worsened at the halfway point in IMRT, further worsened more severely immediately after IMRT, and then improved. The sexual domain of the EPIC significantly decreased at the halfway point in IMRT, which significantly lowered until 24 months. The scores of physical functioning, role physical, bodily pain, vitality, social functioning, and role emotional domains in the SF-8 significantly decreased and reached their lowest points immediately after IMRT. Conclusion QOL worsened the most severely in patients immediately after IMRT for prostate cancer. This knowledge can influence treatment recommendations and enable patients to make better informed decisions.
Collapse
Affiliation(s)
- Yasushi Nakai
- Department of Urology, Nara Medical University, Nara, Japan,
| | | | - Satoshi Anai
- Department of Urology, Nara Medical University, Nara, Japan,
| | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan,
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Nara, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Nara, Japan,
| | - Shunta Hori
- Department of Urology, Nara Medical University, Nara, Japan,
| | | | - Tomomi Fujii
- Department of Pathology, Nara Medical University, Nara, Japan
| | | | | |
Collapse
|