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Effects of Prostate Cancer Therapies on Sexual Function Vary Little in the Long Run

Internal Medicine World Report, June 2005,

Effects of Prostate Cancer Therapies on Sexual Function

Vary Little in the Long Run

ORLANDO—“The effects of cancer treatment on patient quality of life often

play a significant role in treatment decisions, but treatment-related differences diminish over time,” Joycelyn Speight, MD, PhD, of the University of California San Francisco, said at the 2005 Multidisciplinary Prostate Cancer Symposium. She came to this conclusion after studying

2903 men with localized prostate cancer who were asked to evaluate their own sexual

function at 6-month intervals during a 4-year treatment period.

Although all prostate cancer treatments can cause sexual dysfunction by impairing the nerves and vascular structures that control erectile function, it appears that brachytherapy has the least

negative impact. Brachytherapy, the implantation of radioactive seeds in the

prostate, was compared with external beam radiotherapy and radical prostatectomy,

both the nerve-sparing and non—nerve-sparing kind. Most of the

patients received surgery. Those treated with ≥1 forms of radiotherapy were 5 to

10 years older, had significantly more comorbid conditions, and were more

likely to have received hormone deprivation therapy. Immediately after treatment, the radiotherapy group reported significantly better sexual function than those treated surgically.

However, each of the radiotherapy groups began to experience some decline

over the first posttreatment year, which reached a plateau at years 2, 3, and 4. “As

we progressed out from posttreatment to year 4, we noticed that the patients who

received brachytherapy alone had the least overall change in their sexual function,” Dr

Speight reported. In the surgical group, men who received nerve-sparing prostatectomy had a clinically significant improvement in sexual function during the first year, followed by a

continual gradual increase through year 4, but the differences between years 1 and 4

were not clinically significant. There were no major differences in sexual function

after 4 years when external beam brachytherapy and nerve-sparing prostatectomy

were compared.—L.D.