Prostate brachytherapy preserves erectile function

NEW YORK (Reuters Health) - Among men with good sexual function before treatment with low-dose brachytherapy for prostate cancer, erectile function is likely to remain good over the long term, according to a report in the medical journal BJU International.

“On average, radiation-treated patients have tended as a group to be a decade older than men who get surgery,” Dr. Jamie A. Cesaretti told Reuters Health. If the outcome is examined for younger men between 50 and 60 years old who are treated with brachytherapy, “one finds that erectile preservation is astonishingly common.”

Low-dose prostate brachytherapy is a procedure that involves the implantation of radioactive “seeds,” about the size of a grain of rice, into the prostate gland tumors. Radioactive isotopes -- iodine and palladium -- are frequently used and sealed within a tiny titanium shell. As the radiation is released from the seeds, the prostate tumors shrink and die.

Cesaretti from Mount Sinai School of Medicine, New York and associates evaluated the effect of low dose-rate prostate brachytherapy on the sexual health of 131 men with at least 7 years of follow-up after treatment for T1b to T3a prostate cancer. T stage refers to the extent of the cancer spread; T1b cancers are limited to the primary site, while T3a cancers have spread outside the initial area.

All of the subjects had optimal erectile function before treatment.

Forty-two of these men (32 percent) developed erectile dysfunction, the authors report, but potency rates were higher for men between 50 and 59 years when implanted (92 percent) than for those between 60 and 69 years (64 percent) or men between 70 and 79 years (58 percent).

Among the 89 patients who reported they retained erectile function after at least 7 years, most (51 percent) were currently using some type of treatment for erectile dysfunction, including phosphodiesterase type 5 inhibitors, yohimbine, or alprostadil.

“I would favor brachytherapy over radical prostatectomy for the preservation of erectile function,” Cesaretti said. Radical prostatectomy involves the complete surgical removal of the prostate, which may cause nerve damage resulting in impotence.

“Large single institution results for brachytherapy are excellent, at least equivalent to the outcome of single institution results of radical prostatectomy by experienced surgeons. We use a multimodality approach to more advanced cancers, which includes the use of hormone therapy and external beam in addition to brachytherapy.”

“We have an ongoing study of the use of prophylactic sildenafil (Viagra) for patients treated with radiation which we hope will further improve the results of erectile function,” Cesaretti commented.

SOURCE: BJU International, August 2007.