Preserving Sexual Function with Vessel-Sparing Radiation Therapy

In men with prostate cancer undergoing curative radiation therapy, it may be possible to preserve sexual function by using a vessel-sparing radiation technique, according to the 5-year follow-up results from a study of men who underwent vessel-sparing radiation therapy in this setting.

At the 2014 American Society for Radiation Oncology meeting, Patrick W. McLaughlin, MD, Professor of Radiation Oncology, University of Michigan, Novi, presented the results of the 5-year follow-up on patients treated with the technique. In 2005, Dr McLaughlin and colleagues defined the vessel-sparing technique.

“Using MRI [magnetic resonance imaging] to define patient’s anatomy, the vessels involved in maintaining an erection can be spared in some patients,” said Dr McLaughlin. “This is not possible in all patients; for example, those with prostate cancer at the apex of the prostate,” Dr McLaughlin said.

The study included 90 men diagnosed with prostate cancer, approximately 50% of whom underwent external beam radiation therapy (EBRT) alone and 50% who received EBRT plus brachytherapy. None of the patients received androgen deprivation therapy.

All forms of cancer therapy affect sexual function, Dr McLaughlin said. A 2009 study showed that among patients with good baseline erectile capacity, after 36 months of prostate cancer therapy, erectile capacity was present in only approximately 30% of those treated with prostatectomy, 50% of those who received EBRT, and 80% of patients who underwent brachytherapy (Chen RC, et al. J Clin Oncol. 2009;27:3916-3922).

Two patient-reported metrics were used to assess sexual function—Metric A, which measured erections suf­ficient for sexual intercourse, and Metric B, which was more general regarding any form of sexual activity.

Using Metric A, which only examined erectile function sufficient for sexual intercourse, at 2 years erectile capacity was achieved in 16.5% of patients of the radiation therapy–alone group and in 20.8% in the group receiving radiation therapy plus brachytherapy. At 5 years, 15.4% and 16.9% of patients, respectively, were able to maintain an erection.

Using Metric B, erectile function sufficient for sexual activity with or without aids was preserved in 78.6% of patients receiving radiation therapy alone and in 91.8% who received radiation therapy plus brachytherapy at 5 years.

Dr McLaughlin said that as people age, sexuality changes and many couples engage in sexual activity other than intercourse, which can be painful to women after menopause—this is why he thinks Metric B is more reflective of sexuality in older people.

The cure rates at the 5-year follow-up were excellent. The cure rates were 98% among low-risk men (55% of patients), 96% among intermediate-risk men (30% of patients), and 87% in high-risk men (5% of patients).

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