Ejaculatory Function Following Stereotactic Body Radiation Therapy for Prostate Cancer. Issue 5 (17th March 2022)

• Record Type: Journal Article
• Authors: Sholklapper, Tamir; Creswell, Michael; Cantalino, Jonathan; Markel, Michael; Zwart, Alan; Danner, Malika; Ayoob, Marilyn; Yung, Thomas; Collins, Brian; Kumar, Deepak; Aghdam, Nima; Rubin, Rachel S.; Hankins, Ryan; Suy, Simeng; Collins, Sean
• Is Part Of: Journal of sexual medicine. Volume 19:Issue 5(2022)
• Page Start: 771
• Page End: 780
• Publication Date: 2022-03-17
• Subjects: Prostate Cancer -- SBRT -- CyberKnife -- Ejaculation; Sexual disorders -- Periodicals; Sex -- Periodicals; Sexual health -- Periodicals; 616.69005
• DOI: 10.1016/j.jsxm.2022.02.018
• Languages: English
• ISSNs: 1743-6095

Abstract

ABSTRACT: Background: Ejaculatory dysfunction is an important male quality of life issue which has not yet been studied in the setting of prostate stereotactic body radiation therapy (SBRT). Aim: The purpose of this study is to evaluate ejaculatory function following SBRT for prostate cancer. Methods: Two hundred and thirty-one patients on a prospective quality of life study with baseline ejaculatory capacity treated with prostate SBRT from 2013 to 2019 were included in this analysis. Ejaculation was assessed via the Ejaculation Scale (ES-8) from the Male Sexual Health Questionnaire. Patients completed the questionnaire at 1, 3, 6, 9, 12, 18, and 24 months post-SBRT. Elderly patients (Age > 70) and those who received hormonal therapy were excluded from analysis. Patients were treated to 35–36.25 Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Outcomes: Ejaculatory function was assessed by ES-8 scores (range 4–40) with lower values representing increased interference or annoyance. Results: Median age at the time of treatment was 65 years. Median follow up was 24 months (IQR 19–24.5 months). 64.5% of patients had ED at baseline (SHIM < 22). The 2-year anejaculation rate was 15%. Mean composite ES-8 scores showed a decline in the first month following treatment then stabilized: 30.4 (start of treatment); 26.5 (1 month); 27.6 (3 month); 27.0 (6 month); 26.2 (9 month); 25.4 (12 month); 25.0 (18 month) and 25.4 (24 month). White race, higher pre-treatment SHIM (≥22), and higher ES-8 (≥31) at treatment start were significantly associated with a decreased probability of a clinically significant decline. Patient-reported ejaculate volume was significantly reduced at all time points post-SBRT. Ejaculatory discomfort peaked at 1 month and 9 months post-SBRT. Prior to treatment, 8.0% of men reported that they were very to extremely bothered by their ejaculatory dysfunction. The number of patients reporting this concern increased to 14.4% at one year and dropped to 11% at 24-months post-SBRT. Clinical Translation: Patients undergoing prostate SBRT may experience meaningful changes in ejaculatory function and should be counseled on the trajectory of these side effects. Strengths & Limitations: This was a retrospective analysis of a prospectively maintained database. Subjective questionnaire responses captured limited aspects of ejaculatory function in this cohort. Conclusion: The high incidence of moderate to extreme bother in ejaculatory function before and after SBRT suggests a need for novel approaches to improving ejaculation.