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18 Predictive Factors for Erectile Dysfunction in Men with Prostate Cancer Following Prostate Brachytherapy: Is Dose to the Penile Bulb Important?
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September 7-10
prostate dosimetry (Vl00, V150 and Dg0), and rectal DVH for VR150%, VR100% and VR50% (volume of the rectum receiving 150, 100 and 50% of the prescribed dose in cc). Acute toxicity was scored on 6 weeks and late toxicity on >6 month follow up using RTOG scale. Results: 21% pts developed acute rectal toxicity: 15% gr 1 and 6 % gr 2. 30% developed late rectal toxicity: 20% gr 1, 9.4% gr 2 and 0.4% gr 3. On MVA, factors predictive for late gr >2 rectal toxicity include: iPSA (p=0.03) and D90 (p=0.033). For D90 <125 Gy, 125-150 Gy, 150-175 Gy and >175 Gy corresponding late grade >2 toxicity is 9%, 6.8%, 10% and 15.5% respectively. If VR100=0 cc: gr >1 and gr >2 late rectal toxicity were 5% vs 0%. If VR100=I cc: gr >1 and gr >2 toxicity were 26% vs 7%. For VR100=2cc: gr >1 and gr >2 toxicity were 3 5% vs 9.5 % respectively. Acute toxicity was predictive of late gr 2 toxicity (6%, 19% and 27% for gr 0, gr 1 and gr 2 acute proctitis respectively; p=<0.01). Acute urinary obstruction was predictor for late gr 2 toxicity (p=0.01), Conclusions: Anterior 1/2 rectum DVH (VR100), D90, AUR, predict late >1 late rectal toxicity. D90 and acute rectal toxicity predict for >2 late rectal toxicity. 18 Predictive Factors for Erectile Dysfunction in Men w i t h P r o s t a t e Cancer Following Prostate B r a c h y t h e r a p y : I s Dose to the Penile Bulb I m p o r t a n t ?
M. Keyes ~, G. MacDonald ~, A. Kruk 2, G. Duncan ~, V. Moravan 3, W.J. Morris 1 Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency Vancouver, British ColumbiaZ; Department of Radiation Therapy, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, British Columbia2; Population and Preventive Oncology, British Columbia Cancer Agency, Vancouver, British Columbia 3 Purpose: To determine predictive factors for post-implant erectile dysfunction (ED), specifically to assess the impact of penile bulb dose. M a t e r i a l and Methods: 342 consecutive patients potent preimplant with at least 2 years follow-up were included in the study. Patient, tumor, treatment and dosimetric data were prospectively collected. The penile bulb was contoured by 2 investigators and D95 and D50 calculated. Post-implant ED was defined by both physicia n-documented. Binary logistic regression analysis was used to create multivariable models of predictors for ED at 1, 2 and 3 years post-implant. Results: Potency preservation rate at 3 year follow up for different age groups include: age <60 = 73%, age 60-69 = 62% and age >70 = 46%. Multivariable analyses revealed age and degree of pre-implant erectile function to be consistent and most significant predictors of ED (p=0.0001) (year 1, 2 and 3 of follow-up). Use of androgen suppression (AS) was significant at the 1 year (p=0.0001), but not thereafter, in keeping with testosterone recovery. Other predictive MVA factors include: implant order (p=0.001), PUTV (p=0.04) and number of needles (p=0.002). These may ultimately point to trauma to the bulb as an important predictive factor of ED. Hypertension (p=0.02), and smoking (0.01) were also predictive. Penile bulb dosimetry was found to predict ED. Recovery of potency (30% of pts. per year) was seen regardless of whether patients had received prior AS or used potency aids. Conclusion: The strongest factors predictive for ED after prostate brachytherapy include age, pretreatment ED and history of AS. Significance of implant order, larger PUTV and number of needles used for implant is suggestive of trauma as a possible cause of ED after prostate Brachytherapy. Dose to the bulb is unrelated to development of ED. Potency recovery (regardless of use of AS and potency aids) is not uncommon.
CARO 2005
19 Sexual Desire C o r r e l a t e s w i t h P r e f e r e n c e s for Short versus Long Term Androgen Deprivation and R a d i o t h e r a p y in P r o s t a t e Cancer Survivors
D. Wilke 1, M. Krahn 2, P, Warde 3, A. Bezjak 3, G. Tomlinson 2, R. Rutledge 1, A. Detsky 4 Nova Scotia Cancer Centre, Dalhousie University, Halifax, Nova Scotia1; University Health Network, University of Toronto, Toronto, Ontario2; Princess Margaret Hospital, University of Toronto, Toronto, Ontario3; Mount Sinai Hospital, University of Toronto, Toronto, Ontario 4 Background: Given a hypothetical scenario, patients may be willing to trade-off survival in order to be spared the side effects of long-term versus short-term androgen deprivation (AD) and radiotherapy for the treatment of Locally Advanced Prostate Cancer. Methods: Sixty-seven prostate cancer survivors who were treated with radiotherapy participated in a structured interview. Current sexual function was assessed using the International Index of Erectile Function (IIEF) and their current prostate cancer-specific health state was assessed using the prostate cancer health state classification system of the Patient Oriented Prostate Utility Scale (PORPUS). Preferences for long versus short-term AD and radiotherapy were elicited using the Probability trade-off (PTO) technique. Results: Given a hypothetical scenario, prostate cancer survivors were willing, on average, to trade off 8.3% [95% C.I.: 7.1 - 9,3%] absolute prostate cancer- specific survival (PCSS) to avoid long-term versus short-term AD. As per RTOG 9202, long versus short-term AD and radiotherapy provides only a 3.4% benefit in PCSS at 5 years. When given the scenario of no improvement in overall survival, patients were still willing to trade survival, but required, on average, an additional 1.5% gain in PCSS (p<0.0001). Willingness to trade survival, using the PTO technique, was correlated with current sexual desire, as measured by the sexual desire domain score of the IIEF (Spearman Rank r=0.5, p<0.0001). Sexual desire domain score remained significant on multivariable analysis of factors related to willingness to trade survival. Conclusion: Prostate cancer survivors are, in theory, willing to trade survival in order to be spared the side effects of long versus short-term androgen deprivation. Sexual desire is correlated with willingness to trade PCSS. 2O The D u r a t i o n of LHRH T r e a t m e n t in Men Radical R a d i o t h e r a p y for P r o s t a t e Cancer
Receiving
P. Blood 1, C. Paul2, ]. Barnett 3, ]. Spinelli~, T. Pickles ~, G. Steinhoff ~ British Columbia Cancer Agency, University of British Columbia, Victoria, British Columbia1; University of British Columbia, Vancouver, British Columbia2; British Columbia Cancer Agency, Victoria, British Columbia3; Gary Steinhoff Clinical Research, Victoria, British Columbia 4 Rationale: Since 1997, randomized trials have shown improved outcomes when LHRH treatment is added to radical radiotherapy for selected patients with prostate cancer. However, there is a wide variation in the duration of LHRH treatment in these studies, from 4 months to 3 years. Little information is available on the extent to which men with prostate cancer are being treated with LHRH injections in this setting. Objectives: To measure the extent to which men receiving radical radiation treatment for prostate cancer are receiving LHRH treatment; by determining the proportion of men receiving LHRH prescriptions and the duration of LHRH prescriptions associated with radical radiation treatment. Methods: A cohort of men diagnosed with prostate cancer between 1986 and 2000 was assembled from the Provincial Cancer Registry. The start date of radiation treatment was
September 7-10
prostate dosimetry (Vl00, V150 and Dg0), and rectal DVH for VR150%, VR100% and VR50% (volume of the rectum receiving 150, 100 and 50% of the prescribed dose in cc). Acute toxicity was scored on 6 weeks and late toxicity on >6 month follow up using RTOG scale. Results: 21% pts developed acute rectal toxicity: 15% gr 1 and 6 % gr 2. 30% developed late rectal toxicity: 20% gr 1, 9.4% gr 2 and 0.4% gr 3. On MVA, factors predictive for late gr >2 rectal toxicity include: iPSA (p=0.03) and D90 (p=0.033). For D90 <125 Gy, 125-150 Gy, 150-175 Gy and >175 Gy corresponding late grade >2 toxicity is 9%, 6.8%, 10% and 15.5% respectively. If VR100=0 cc: gr >1 and gr >2 late rectal toxicity were 5% vs 0%. If VR100=I cc: gr >1 and gr >2 toxicity were 26% vs 7%. For VR100=2cc: gr >1 and gr >2 toxicity were 3 5% vs 9.5 % respectively. Acute toxicity was predictive of late gr 2 toxicity (6%, 19% and 27% for gr 0, gr 1 and gr 2 acute proctitis respectively; p=<0.01). Acute urinary obstruction was predictor for late gr 2 toxicity (p=0.01), Conclusions: Anterior 1/2 rectum DVH (VR100), D90, AUR, predict late >1 late rectal toxicity. D90 and acute rectal toxicity predict for >2 late rectal toxicity. 18 Predictive Factors for Erectile Dysfunction in Men w i t h P r o s t a t e Cancer Following Prostate B r a c h y t h e r a p y : I s Dose to the Penile Bulb I m p o r t a n t ?
M. Keyes ~, G. MacDonald ~, A. Kruk 2, G. Duncan ~, V. Moravan 3, W.J. Morris 1 Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency Vancouver, British ColumbiaZ; Department of Radiation Therapy, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, British Columbia2; Population and Preventive Oncology, British Columbia Cancer Agency, Vancouver, British Columbia 3 Purpose: To determine predictive factors for post-implant erectile dysfunction (ED), specifically to assess the impact of penile bulb dose. M a t e r i a l and Methods: 342 consecutive patients potent preimplant with at least 2 years follow-up were included in the study. Patient, tumor, treatment and dosimetric data were prospectively collected. The penile bulb was contoured by 2 investigators and D95 and D50 calculated. Post-implant ED was defined by both physicia n-documented. Binary logistic regression analysis was used to create multivariable models of predictors for ED at 1, 2 and 3 years post-implant. Results: Potency preservation rate at 3 year follow up for different age groups include: age <60 = 73%, age 60-69 = 62% and age >70 = 46%. Multivariable analyses revealed age and degree of pre-implant erectile function to be consistent and most significant predictors of ED (p=0.0001) (year 1, 2 and 3 of follow-up). Use of androgen suppression (AS) was significant at the 1 year (p=0.0001), but not thereafter, in keeping with testosterone recovery. Other predictive MVA factors include: implant order (p=0.001), PUTV (p=0.04) and number of needles (p=0.002). These may ultimately point to trauma to the bulb as an important predictive factor of ED. Hypertension (p=0.02), and smoking (0.01) were also predictive. Penile bulb dosimetry was found to predict ED. Recovery of potency (30% of pts. per year) was seen regardless of whether patients had received prior AS or used potency aids. Conclusion: The strongest factors predictive for ED after prostate brachytherapy include age, pretreatment ED and history of AS. Significance of implant order, larger PUTV and number of needles used for implant is suggestive of trauma as a possible cause of ED after prostate Brachytherapy. Dose to the bulb is unrelated to development of ED. Potency recovery (regardless of use of AS and potency aids) is not uncommon.
CARO 2005
19 Sexual Desire C o r r e l a t e s w i t h P r e f e r e n c e s for Short versus Long Term Androgen Deprivation and R a d i o t h e r a p y in P r o s t a t e Cancer Survivors
D. Wilke 1, M. Krahn 2, P, Warde 3, A. Bezjak 3, G. Tomlinson 2, R. Rutledge 1, A. Detsky 4 Nova Scotia Cancer Centre, Dalhousie University, Halifax, Nova Scotia1; University Health Network, University of Toronto, Toronto, Ontario2; Princess Margaret Hospital, University of Toronto, Toronto, Ontario3; Mount Sinai Hospital, University of Toronto, Toronto, Ontario 4 Background: Given a hypothetical scenario, patients may be willing to trade-off survival in order to be spared the side effects of long-term versus short-term androgen deprivation (AD) and radiotherapy for the treatment of Locally Advanced Prostate Cancer. Methods: Sixty-seven prostate cancer survivors who were treated with radiotherapy participated in a structured interview. Current sexual function was assessed using the International Index of Erectile Function (IIEF) and their current prostate cancer-specific health state was assessed using the prostate cancer health state classification system of the Patient Oriented Prostate Utility Scale (PORPUS). Preferences for long versus short-term AD and radiotherapy were elicited using the Probability trade-off (PTO) technique. Results: Given a hypothetical scenario, prostate cancer survivors were willing, on average, to trade off 8.3% [95% C.I.: 7.1 - 9,3%] absolute prostate cancer- specific survival (PCSS) to avoid long-term versus short-term AD. As per RTOG 9202, long versus short-term AD and radiotherapy provides only a 3.4% benefit in PCSS at 5 years. When given the scenario of no improvement in overall survival, patients were still willing to trade survival, but required, on average, an additional 1.5% gain in PCSS (p<0.0001). Willingness to trade survival, using the PTO technique, was correlated with current sexual desire, as measured by the sexual desire domain score of the IIEF (Spearman Rank r=0.5, p<0.0001). Sexual desire domain score remained significant on multivariable analysis of factors related to willingness to trade survival. Conclusion: Prostate cancer survivors are, in theory, willing to trade survival in order to be spared the side effects of long versus short-term androgen deprivation. Sexual desire is correlated with willingness to trade PCSS. 2O The D u r a t i o n of LHRH T r e a t m e n t in Men Radical R a d i o t h e r a p y for P r o s t a t e Cancer
Receiving
P. Blood 1, C. Paul2, ]. Barnett 3, ]. Spinelli~, T. Pickles ~, G. Steinhoff ~ British Columbia Cancer Agency, University of British Columbia, Victoria, British Columbia1; University of British Columbia, Vancouver, British Columbia2; British Columbia Cancer Agency, Victoria, British Columbia3; Gary Steinhoff Clinical Research, Victoria, British Columbia 4 Rationale: Since 1997, randomized trials have shown improved outcomes when LHRH treatment is added to radical radiotherapy for selected patients with prostate cancer. However, there is a wide variation in the duration of LHRH treatment in these studies, from 4 months to 3 years. Little information is available on the extent to which men with prostate cancer are being treated with LHRH injections in this setting. Objectives: To measure the extent to which men receiving radical radiation treatment for prostate cancer are receiving LHRH treatment; by determining the proportion of men receiving LHRH prescriptions and the duration of LHRH prescriptions associated with radical radiation treatment. Methods: A cohort of men diagnosed with prostate cancer between 1986 and 2000 was assembled from the Provincial Cancer Registry. The start date of radiation treatment was