Comparison Of Long-Term Urinary And Sexual Morbidity In Patients With Prostate Cancer Treated With Different Brachytherapy Regimens

We describe long-term urinary and sexual morbidity resulting from 4 different brachytherapy regimens for prostate cancer: (1) brachytherapy (BR) alone, (2) BR + hormones (HR), (3) BR + external beam radiation therapy (EBRT), and (4) BR + EBRT + HR. From 1993-2007, 2031 patients were treated for prostate cancer, as follows: 826 patients with BR alone with either I-125 (D90 = 160 Gy) or Pd-103 (D90 = 124 Gy); 512 patients with BR + HR; 83 patients with BR with Pd-103 (D90 = 100 Gy) + EBRT (45 Gy) to the prostate; 610 patients with BR + EBRT + HR. We prospectively collected data to determine the effects of therapy on urinary irritative symptoms using patient-assessed International Prostate Symptom Score (IPSS) questionnaire, and sexual function using both patient-assessed Sexual Health Inventory for Men (SHIM) questionnaire and physician-assessed Mount Sinai Erectile Function (MSEF) scores (where 0 = no erectile function, 1 = erections insufficient for intercourse, 2 = erections sufficient for intercourse but suboptimal, and 3 = full and optimal erections). Median follow-up was 73 months. Compared to pretreatment IPSS scores, the mean change in IPSS scores at 5 year follow-up was: 0.8 for group (1); -0.6 for group (2); 2.7 for group (3); 0.9 for group (4) (p = 0.01). Compared to pretreatment SHIM scores, the mean change in SHIM scores at 5 year follow-up was: -4.1 for group (1); -5.1 for group (2); -5.9 for group (3); -4.6 for group (4) (p = 0.7). For patients with a pretreatment physician-assessed MSEF score of ≥2, the percentage of patients with a MSEF score of ≤1 at 5 year follow-up was: 14.0% for group (1); 20.0% for group (2); 38.1% for group (3); 63.5% for group (4) (p < 0.01). Of the 4 treatment groups, only treatment with BR plus EBRT (without HR) has a pronounced, though modest, negative impact upon long-term urinary irritative symptoms. BR plus HR may in fact improve long term urinary irritative symptoms. There is no difference in long-term sexual morbidity between the treatment groups, as determined by patient assessed SHIM questionnaires. However, significant difference is seen in long-term sexual function as determined by the physician assessed MSEF score, with BR alone causing the lowest rates of loss of sexual function.