Patient-Reported Sexual Survivorship Following High-Dose Image-Guided Proton Therapy for Prostate Cancer. (May 2019)

• Record Type: Journal Article
• Authors: Holtzman, Adam L.; Bryant, Curtis M.; Mendenhall, Nancy P.; Mendenhall, William M.; Nichols, R. Charles; Henderson, Randal H.; Figura, Nicholas; Morris, Christopher G.; Williams, Christopher R.; Li, Zoufeng; Hoppe, Bradford S.
• Is Part Of: Radiotherapy and oncology. Volume 134(2019)
• Page Start: 204
• Page End: 210
• Publication Date: 2019-05
• Subjects: Radiotherapy -- Prostate cancer -- Sexual outcomes -- Erectile function; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2019.01.029
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Identify health-related factors that predict erectile function after high-dose IGRT. Potency rates at 6 months, 2 years, and 5 years after IGRT were 81%, 68%, and 61%. EPIC subset questions with baseline comorbidities can help predict potency after IGRT. Abstract: Objective: To help guide individualized treatment, we sought to identify baseline predictive factors that impact long-term erectile function following high-dose image-guided radiotherapy (HD-IGRT). Methods: Potent men with localized prostate cancer treated with radiotherapy alone were enrolled in an institutional review board-approved prospective cohort study. Men received HD-IGRT as primary treatment of prostate cancer. Patient-reported inventories were used to assess erectile function at baseline, 6 months, 2 years, and 5 years after treatment. Long-term potency rates were compared to validated models, and baseline factors were used to create a novel, internally validated nomogram for predicting long-term function. Results: 1, 159 men were treated with HD-IGRT. Among 676 men who were potent at baseline and did not receive hormone therapy, the potency rates at 6 months, 2 years, and 5 years were 81%, 68%, and 61%. Recursive partitioning categorized patients into 3 groups based on two factors: baseline response to EPIC Q57 (ability to have an erection) and pre-existing heart disease. At 5 years, the most favorable group reported "very good" on Q57 and had an 80% potency rate ( n = 137; p = 0.83); the intermediate group reported "good" on Q57 and had no baseline cardiac disease with a 62% potency rate ( n = 145; p = 0.86); and the remaining poor risk group had a 37% potency rate ( n = 117; p = 0.19). Conclusions: Patient-reported pretreatment sexual function and comorbidities enables stratification and prediction of erectile function. EPIC subset questions with baseline comorbidities may potentially serve as a quick and practical clinical tool for predicting sexual survivorship.