Abstract
Each of the three most common contemporary treatments for localized prostate cancer, radical prostatectomy, external beam radiotherapy, and brachytherapy, can have adverse effects on sexual health. Sexual health outcome can be improved by treatment-specific factors, such as the use of nerve-sparing technique during radical prostatectomy, or worsened by the use of androgen deprivation before external beam radiotherapy or brachytherapy. Contemporary studies that have used validated questionnaires to evaluate multiple components of patient-reported sexuality following prostate cancer treatments provide benchmarks of sexual outcome expectations that are of interest to patients selecting their prostate cancer treatment.
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References and Recommended Reading
American Cancer Society: Cancer Facts and Figures 2003. American Cancer Society: 2003.
Talcott JA, Manola J, Clark JA, et al.: Time course and predictors of symptoms after primary prostate cancer therapy. J Clin Oncol 2003, 21:3979–3986. Single-institution prospective study of predominantly radiation and brachytherapy patients and some prostatectomy cases criticized for sparse use of nerve-sparing.
Singer PA, Tasch ES, Stocking C, et al.: Sex or survival: tradeoffs between quality and quantity of life. J Clin Oncol 1991, 9:328–334.
Litwin MS: Measuring quality of life after prostate cancer treatment.[comment]. Cancer J Sci Am 1999, 5:211–213.
NIH Consensus Conference: Impotence: NIH Consensus Development Panel on Impotence [Review]. JAMA 1993, 270:83–90.
Cooperberg MR, Koppie TM, Lubeck DP, et al.: How potent is potent? Evaluation of sexual function and bother in men who report potency after treatment for prostate cancer: data from CaPSURE. Urology 2003, 61:190–196. This article raises poignant issues of how what one observes depends on what one measures: is the glass half empty or half full?
Walsh PC: Radical prostatectomy for localized prostate cancer provides durable cancer control with excellent quality of life: a structured debate [comment]. J Urol 2000, 163:1802–1807.
Smith JA Jr: Editorial: sexual function after radical prostatectomy [comment]. J Urol 2003, 169:1465.
Brucker PS, Cella D: Measuring self-reported sexual function in men with prostate cancer. Urology 2003, 62:596–606.
Quinlan DM, Epstein JI, Carter BS, Walsh PC: Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J Urol 1991, 145:998–1002.
Rabbani F, Stapleton AM, Kattan MW, et al.: Factors predicting recovery of erections after radical prostatectomy [comment]. J Urol 2000, 164:1929–1934.
Catalona WJ, Carvalhal GF, Mager DE, Smith DS: Potency, continence, and complication rates in 1870 consecutive radical retropubic prostatectomies. J Urol 1999, 162:433–438.
Litwin MS, Lubeck DP, Henning JM, Carroll PR: Differences in urologist and patient assessments of health related quality of life in men with prostate cancer: results of the CaPSURE database. J Urol 1998, 159:1988–1992.
Wei JT, Dunn RL, Sandler HM, et al.: Comprehensive comparison of health-related quality of life after contemporary therapies for localized prostate cancer. J Clin Oncol 2002, 20:557–566. First study evaluating brachytherapy as well as prostatectomy and external radiation, including effect of neoadjuvant hormone therapy, using a common instrument (EPIC).
Litwin MS, Hays RD, Fink A, et al.: Quality-of-life outcomes in men treated for localized prostate cancer [comment]. JAMA 1995, 273:129–135.
Schover LR, Fouladi RT, Warneke CL, et al.: Defining sexual outcomes after treatment for localized prostate carcinoma. Cancer 2002, 95:1773–1785. Detailed characterization of sexuality and medications/devices used by survivors.
Bacon CG, Giovannucci E, Testa M, Kawachi I: The impact of cancer treatment on quality of life outcomes for patients with localized prostate cancer. J Urol 2001, 166:1804–1810.
Brandeis JM, Litwin MS, Burnison CM, Reiter RE: Quality of life outcomes after brachytherapy for early stage prostate cancer. J Urol 2000, 163:851–857.
Davis JW, Kuban DA, Lynch DF, Schellhammer PF: Quality of life after treatment for localized prostate cancer: differences based on treatment modality. J Urol 2001, 166:947–952.
Litwin MS, Hays RD, Fink A, et al.: The UCLA Prostate Cancer Index: development, reliability, and validity of a health-related quality of life measure. Med Care 1998, 36:1002–1012.
Cohen J: Statistical Power Analysis for Behavioral Sciences, edn 8. New York: Academic Press; 1977.
Hollenbeck BK, Dunn RL, Wei JT, et al.: Determinants of long-term sexual health outcome after radical prostatectomy measured by a validated instrument. J Urol 2003, 169:1453–1457.
Wei JT, Dunn RL, Litwin MS, et al.: Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology 2000, 56:899–905.
Talcott JA, Rieker P, Propert KJ, et al.: Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy [comment]. J Natl Cancer Inst 1997, 89:1117–1123.
Talcott JA, Rieker P, Clark JA, et al.: Patient-reported symptoms after primary therapy for early prostate cancer: results of a prospective cohort study. J Clin Oncol 1998, 16:275–283.
Potosky AL, Legler J, Albertsen PC, et al.: Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study. J Natl Cancer Inst 2000, 92:1582–1592. First prospective study evaluating sexual outcome after various prostate cancer treatments in community setting.
Gralnek D, Wessells H, Cui H, Dalkin BL: Differences in sexual function and quality of life after nerve-sparing and nonnerve sparing radical retropubic prostatectomy. J Urol 2000, 163:1166–1169.
Walsh PC: Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy. J Urol 1998, 159:308–309.
Litwin MS, Flanders SC, Pasta DJ, et al.: Sexual function and bother after radical prostatectomy or radiation for prostate cancer: multivariate quality-of-life analysis from CaPSURE. Cancer of the Prostate Strategic Urologic Research Endeavor. Urology 1999, 54:503–508.
Litwin MS, McGuigan KA: Accuracy of recall in health-related quality-of-life assessment among men treated for prostate cancer. J Clin Oncol 1999, 17:2882–2888.
Litwin MS, Melmed GY, Nakazon T: Life after radical prostatectomy: a longitudinal study [comment]. J Urol 2001, 166:587–592. Prospective assessment of sexuality among prostatectomy patients.
Lubeck DP, Litwin MS, Henning JM, et al.: Changes in healthrelated quality of life in the first year after treatment for prostate cancer: results from CaPSURE. Urology 1999, 53:180–186.
Downs TM, Sadetsky N, Pasta DJ, et al.: Health-related quality of life patterns in patients treated with interstitial prostate brachytherapy for localized prostate cancer: data from CaPSURE. J Urol 2003, 170:1822–1827.
Fulmer BR, Bissonette EA, Petroni GR, Theodorescu D: Prospective assessment of voiding and sexual function after treatment for localized prostate carcinoma: comparison of radical prostatectomy to hormonobrachytherapy with and without external beam radiotherapy. Cancer 2001, 91:2046–2055.
Incrocci L, Slob AK, Levendag PC: Sexual (dys)function after radiotherapy for prostate cancer: a review. Int J Radiat Oncol Biol Phys 2002, 52:681–693.
Turner SL, Adams K, Bull CA, Berry MP: Sexual dysfunction after radical radiation therapy for prostate cancer: a prospective evaluation. Urology 1999, 54:124–129.
Beard CJ, Propert KJ, Rieker PP, et al.: Complications after treatment with external-beam irradiation in early-stage prostate cancer patients: a prospective multi-institutional outcomes study. J Clin Oncol 1997, 15:223–229.
Zelefsky MJ, Wallner KE, Ling CC, et al.: Comparison of the 5-year outcome and morbidity of three-dimensional conformal radiotherapy versus transperineal permanent iodine-125 implantation for early-stage prostatic cancer. J Clin Oncol 1999, 17:517–522.
Bolla M, Gonzalez D, Warde P, et al.: Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin [comment]. N Engl J Med 1997, 337:295–300.
Potosky AL, Reeve BB, Clegg LX, et al.: Quality of life following localized prostate cancer treated initially with androgen deprivation therapy or no therapy [comment]. J Natl Cancer Inst 2002, 94:430–437.
McCammon KA, Kolm P, Main B, Schellhammer PF: Comparative quality-of-life analysis after radical prostatectomy or external beam radiation for localized prostate cancer. Urology 1999, 54:509–516.
Smith DS, Carvalhal GF, Schneider K, et al.: Quality-of-life outcomes for men with prostate carcinoma detected by screening. Cancer 2000, 88:1454–1463.
Hollenbeck BK, Wei J, Sanda MG, et al.: Neoadjuvant hormone therapy impairs sexual outcome among younger men that undergo external beam radiotherapy for localized prostate cancer. Urology 2004, in press.
Lilleby W, Fossa SD, Waehre HR, Olsen DR: Long-term morbidity and quality of life in patients with localized prostate cancer undergoing definitive radiotherapy or radical prostatectomy. Int J Radiat Oncol Biol Phys 1999, 43:735–743.
Chen CT, Valicenti RK, Lu J, et al.: Does hormonal therapy influence sexual function in men receiving 3D conformal radiation therapy for prostate cancer? Int J Radiat Oncol Biol Phys 2001, 50:591–595.
Staff I, Salner A, Bohannon R, et al.: Disease-specific symptoms and general quality of life of patients with prostate carcinoma before and after primary three-dimensional conformal radiotherapy. Cancer 2003, 98:2335–2343.
Wilder RB, Chou RH, Ryu JK, et al.: Potency preservation after three-dimensional conformal radiotherapy for prostate cancer: preliminary results. Am J Clin Oncol 2000, 23:330–333.
Roach M III, Chinn DM, Holland J, Clarke M: A pilot survey of sexual function and quality of life following 3D conformal radiotherapy for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 1996, 35:869–874.
Chinn DM, Holland J, Crownover RL, Roach M III: Potency following high-dose three-dimensional conformal radiotherapy and the impact of prior major urologic surgical procedures in patients treated for prostate cancer. Int J Radiat Oncol Biol Phys 1995, 33:15–22.
Siston AK, Knight SJ, Slimack NP, et al.: Quality of life after a diagnosis of prostate cancer among men of lower socioeconomic status: results from the Veterans Affairs Cancer of the Prostate Outcomes Study. Urology 2003, 61:172–178. Sexuality outcome perspective focusing on lower socioeconomic class, which usually is under-represented in other such studies.
Stock RG, Stone NN, Iannuzzi C: Sexual potency following interactive ultrasound-guided brachytherapy for prostate cancer. Int J Radiat Oncol Biol Phys 1996, 35:267–272.
Ragde H, Blasko JC, Grimm PD, et al.: Interstitial iodine-125 radiation without adjuvant therapy in the treatment of clinically localized prostate carcinoma [comment]. Cancer 1997, 80:442–453.
Lee WR, Moughan J, Owen JB, Zelefsky MJ: The 1999 patterns of care study of radiotherapy in localized prostate carcinoma: a comprehensive survey of prostate brachytherapy in the United States. Cancer 2003, 98:1987–1994.
Hollenbeck BK, Dunn RL, Wei JT, et al.: Neoadjuvant hormonal therapy and older age are associated with adverse sexual health-related quality-of-life outcome after prostate brachytherapy. Urology 2002, 59:480–484.
Merrick GS, Butler WM, Galbreath RW, et al.: Erectile function after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2002, 52:893–902.
Stock RG, Kao J, Stone NN: Penile erectile function after permanent radioactive seed implantation for treatment of prostate cancer [comment]. J Urol 2001, 165:436–439.
Sanchez-Ortiz RF, Broderick GA, Rovner ES, et al.: Erectile function and quality of life after interstitial radiation therapy for prostate cancer. Int J Impot Res 2000, 12(suppl 3):S18-S24.
Krupski T, Petroni GR, Bissonette EA, Theodorescu D: Qualityof-life comparison of radical prostatectomy and interstitial brachytherapy in the treatment of clinically localized prostate cancer. Urology 2000, 55:736–742.
Potters L, Torre T, Fearn PA, et al.: Potency after permanent prostate brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2001, 50:1235–1242.
Talcott JA, Clark JA, Stark PC, Mitchell SP: Long-term treatment related complications of brachytherapy for early prostate cancer: a survey of patients previously treated. J Urol 2001, 166:494–499.
Kleinberg L, Wallner K, Roy J, et al.: Treatment-related symptoms during the first year following transperineal 125I prostate implantation. Int J Radiat Oncol Biol Phys 1994, 28:985–990.
Hamilton AS, Stanford JL, Gilliland FD, et al.: Health outcomes after external-beam radiation therapy for clinically localized prostate cancer: results from the Prostate Cancer Outcomes Study. J Clin Oncol 2001, 19:2517–2526.
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Hollenbeck, B.K., Dunn, R.L., Wei, J.T. et al. Sexual health recovery after prostatectomy, external radiation, or brachytherapy for early stage prostate cancer. Curr Urol Rep 5, 212–219 (2004). https://doi.org/10.1007/s11934-004-0039-1
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DOI: https://doi.org/10.1007/s11934-004-0039-1