Sept. 20, 2011 – The likely prospect of erectile dysfunction after treatment for prostate cancer is certainly one of the
worst fears of men facing decisions on their treatment. There is helpful news, however, from scientists who have developed a means of
predicting erectile function two years after treatment, which can help men in better understanding their recovery and making educated
decisions.
The development of these prediction models that included variables such as pretreatment sexual function, patient
characteristics and treatment factors appear to be effective at predicting erectile function 2 years after prostatectomy, external
radiotherapy, or brachytherapy for prostate cancer, according to the study in the September 21 issue of the Journal of the American Medical
Association (JAMA).
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"Because most patients survive early-stage prostate cancer, after treatment, health-related quality of life (HRQOL)
outcomes have emerged as a major emphasis in treatment decisions,” according to the researching report.
“Erectile dysfunction is commonplace after prostate cancer treatment and has significant consequences for HRQOL. Among
urinary, bowel, vitality, and sexual HRQOL domains - outcomes commonly impaired by prostate cancer treatment - sexual function in previously
potent men is the most commonly impaired and is closely related to outcome satisfaction."
Information regarding how the combination of pretreatment patient characteristics and treatment factors relate to
individualized sexual outcome remains limited.
The study was to determine whether an individual man's sexual outcomes after the most common treatments for early-stage
prostate cancer can be predicted accurately based on baseline characteristics and treatment plans. It was conducted by Mehrdad Alemozaffar,
M.D., of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and colleagues.
Information from an academic multicenter cohort (enrolled from 2003 through 2006), including pretreatment patient
characteristics, sexual HRQOL, and treatment details, was used to develop models predicting erectile function 2 years after treatment.
A community-based cohort (CaPSURE; enrolled 1995 through 2007) externally validated the performance of the model.
Patients in U.S. academic and community-based practices whose HRQOL was measured pretreatment (1,201 patients) underwent
follow-up after prostatectomy, external radiotherapy, or brachytherapy for prostate cancer.
Sexual outcomes among men completing 2 years of follow-up (1,027 men) were used to develop models predicting erectile
function that were externally validated among 1,913 patients in a community-based cohort.
The researchers found that 2 years after treatment, the ability to attain functional erections suitable for intercourse,
was found in men who received these primary treatments:
● 177 of 511 (35 percent) men who underwent prostatectomy;
● 84 of 229 (37 percent) of men who had received external radiotherapy; and
● 107 of 247 (43 percent) of men who received brachytherapy.
"Pretreatment sexual HRQOL score, age, serum prostate-specific antigen level, race/ethnicity, body mass index, and
intended treatment details were associated with functional erections 2 years after treatment.
“Multivariable logistic regression models predicting erectile function estimated 2-year function probabilities from as
low as 10 percent or less to as high as 70 percent or greater depending on the individual's pretreatment patient characteristics and treatment
details.
“The models performed well in predicting erections in external validation among CaPSURE cohort patients," the authors
write.
"We have developed clinically applicable models to predict recovery of erectile function following prostatectomy,
external radiotherapy, or brachytherapy for early-stage prostate cancer based on pretreatment sexual function, patient characteristics, and
specific plan of treatment.
“External validation of this predictive model in a community-based cohort suggests that these findings are generalizable
and may help physicians and patients to set personalized expectations regarding prospects for erectile function in the years following primary
treatment for prostate cancer," the researchers conclude.
Editorial: 'no decision about me, without me’
Helping Patients Make Better Decisions
In an accompanying editorial, Michael J. Barry, M.D., of Massachusetts General Hospital, Boston, writes that routinely
collecting objective measures of subjective phenomena from patients will need to become part of usual care rather than just research to
optimize outcome prediction.
"More importantly, better ways of ensuring that patients are informed about their choices and invited to participate in
making decisions need to be identified and disseminated.
“Outcomes data for all important options and outcomes need to be integrated in a useful synthesis for the broad spectrum
of men facing this decision. A meta-analysis of randomized trials of patient decision aids to support a shared decision-making process for
preference-sensitive conditions demonstrated better decision quality when these tools are used.
“For the most fateful decisions, coaches or navigators may be helpful and efficient as well.
"The promise of patient-centered outcomes research will be realized not only when high-quality outcomes data are
available for all common medical problems but also when patients are routinely informed and invited to participate in their health care
decisions. To achieve this promise, patients must increasingly be encouraged to adopt the position of 'no decision about me, without me.'"
Keep up with the latest news for senior citizens, baby
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Larger
graphs of prostate cancer cases and deaths 1987-2007 below story
CMS
also to continue expensive breast cancer drug, Avastin; Sipuleucel-T activates immune system to defend
against prostate cancer; first approved autologus cellular immunotherapy
