BOSTONOne year after prostate cancer treatment, men
who had radiation therapy were more likely to be able to maintain an erection
than those who had radical prostatectomy, according to a study presented at the
42nd Annual Meeting of the American Society for Therapeutic Radiology and
John W. Robinson, PhD, clinical psychologist, University of
Calgary and Tom Baker Cancer Centre, Calgary, Alberta, Canada, reported that
brachytherapy produced the best results76% of patients had erectile function
at 1 year. Cryotherapy had the worst results, with only 14% of patients able to
have an erection at 1 year after treatment.
In between were external beam radiation therapy (68%),
brachytherapy combined with external beam radiotherapy (58%), nerve-sparing
radical prostatectomy (58%), and standard radical prostatectomy (30%).
"All other things being equal, I would recommend radiation
therapy," said Dr. Robinson, who specializes in the effects of cancer
treatment on sexuality. He began the study, he explained, because patients
often come to him for help in choosing among treatments.
"Patients ask, ‘What is the likelihood that I’m going
to be able to have erections afterward?’" he told ONI in a
postconference interview. He explained that he was uncomfortable answering
based on the information available.
Not finding any standardized trials comparing treatments with
respect to erectile function, Dr. Robinson and his colleagues based their
analysis on 86 journal articles published from 1970 to 2000. Patients in these
studies had their erectile function assessed both before and after treatment.
The researchers only considered studies that reported data on men who were able
to hold an erection for intercourse prior to treatment, he said, and were
careful not to include duplication of the same patient data.
Dr. Robinson said that drawing inferences from the results of
this meta-analysis is difficult because the age and condition of the patients
could tilt the analysis.
"Radiation therapy is often used on older and sicker
patients," he said. "If the patients were younger with less advanced
diseaselike those often treated with surgerythen the percentage of
patients who maintain erectile function following radiation therapy would
likely be even higher." Conversely, he speculated that brachytherapy might
have had the best results because it is usually used in patients with smaller
tumors and lower-stage disease.
As for cryotherapy, Dr. Robinson said, "it seems to be a
lot harder on erectile capabilities than other treatments." The freezing
of the neurovascular bundles and the placement of probes through the penis
might do some damage, he speculated, adding that the hope is these nerves can
regenerate over time.
Dr. Robinson said he was encouraged that some clinical trials
assessing erectile function after prostate cancer treatment are now taking
"Most consensus panels come to the conclusion that cure
rates are equivalent for radiation therapy and prostatectomy," he said.
"Hence, quality-of-life data become very important when we try to help
patients make decisions about which treatments are best for them."
He added, however, that while he favors doctors being able to
give patients more information about erectile function after prostate cancer
treatment, he is worried that people are taking "a very myopic view of
Dr. Robinson said that physicians should encourage people to
take a broader perspective of sexual arousal. "There’s so much focus on
erectile function, on the belief that if you can’t get an erection, your sex
life is over," he said. "A lot of men don’t know they can have an
orgasm even if they can’t have an erection."