Prospective evaluation of erectile function using International Index of Erectile Function score after 125I permanent prostate brachytherapy

Prospective evaluation of erectile function using International Index of Erectile Function score after 125I permanent prostate brachytherapy

Oral Presentations / Brachytherapy 8 (2009) 105e180 PO85 Association between erectile function and lower urinary tract symptoms in patients treated wi...

44KB Sizes 0 Downloads 94 Views

Oral Presentations / Brachytherapy 8 (2009) 105e180 PO85 Association between erectile function and lower urinary tract symptoms in patients treated with permanent seed prostate brachytherapy Daniel Taussky, M.D.1 Guila Delouya, M.D.1 Aihua Liu, MSc2 Fabio Lefebvre1 Michal Abrahamowicz, M.D.2 Jean-Paul Bahary, M.D.1 David Donath, M.D.1 1Radiation Oncology University of Montreal, Montreal, QC, Canada; 2Epidemiology & Biostatistics, McGill University, Montreal, QC, Canada. Purpose: Epidemiological studies indicate a strong link between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in the aging male. We investigated whether the development of urinary toxicity after permanent seed prostate brachytherapy is associated with erectile function (EF) and the factors associated with EF before brachytherapy. Methods and Materials: We analyzed the data of 215 consecutive patients treated with permanent seed brachytherapy only for low-risk prostate cancer (
PO86 Prospective evaluation of erectile function using International Index of Erectile Function score after 125I permanent prostate brachytherapy Nikhilesh G. Patil, M.D.1 Manipdip Aneja, R.N.2 David Zhou, BEng2 Juanita M. Crook, M.D.1 1Radiation Oncology Princess Margaret Hospital, Toronto, ON, Canada; 2Radiation Medicine, Princess Margaret Hospital, Toronto, ON, Canada. Purpose: To evaluate potency preservation after permanent prostate brachytherapy using International Index of Erectile Function (IIEF-5)

171

with concomitant use of phosphodiesterase-5 inhibitor (PDE5) as required. Methods and Materials: 148 men with favorable risk prostate cancer underwent permanent Iodine 125 prostate brachytherapy from August 2005 to December 2006. 109 men with a baseline IIEF score over 16 were included in the study. None received hormonal therapy. 95% were treated with brachytherapy alone and 5% received supplemental external beam. Implants were pre-planned using TRUS and performed under TRUS and fluoroscopic guidance using loose seeds, with a median activity of 0.32 mCi per seed. 25 e 30 % of seeds were planned outside the prostate volume for a planned PTV dose of 145 Gy. IIEF score was recorded at baseline, 12, and 24 months with a maximum score of 25. According to the IIEF-5 scores, Erectile Dysfunction (ED) is classified as: mild (17 to 21), mild to moderate (12 to 16), moderate (8 to 11), and severe (5 to 7). 6 % of patients were regularly using PDE5’s at baseline. The proportion of current and former smokers is 11% and 41% respectively. Diabetes mellitus was noted in 5%, cardiac conditions in 9% and 2% were on anti-depressants. Results: Median age was 63 yrs (range 46-78). Mean baseline IIEF score was 22 (SD: 2.5). At 12 months it was 17 (SD: 7.3)(p 5 0.000) and at 24 months (n 5 29) it was 19 (SD: 5). 92% are sexually active after brachytherapy with 84% having satisfactory erectile function. PDE-5’s are used at least some of the time in 54%. Only 6% have severe ED post brachytherapy. There is a statistically significant negative co-relation between age and IIEF score at baseline (p!0.001, Pearson’s coefficient 5 0.337), with a trend towards significance at 12 months (p 5 0.06, Pearson’s coefficient 5 0.181). The co-morbidities did not have any impact on IIEF scores post brachytherapy. Conclusions: Although prostate brachytherapy may affect erectile function, 92% of men maintained adequate erections. Proactive use of PDE5’s after brachytherapy may help improve and maintain erectile function. Prospective documentation of sexual function with IIEF scores pre and post prostate brachytherapy is important as it documents pre-existing problems and allows men to maintain realistic expectations following treatment.

PO87 Pulmonary seed embolization after transperineal interstitial prostate brachytherapy: Does small prostate gland or seed placement outside the prostate capsule increase frequency of seed loss? Junaid Yousuf, M.D.1 Bashir Bashir, M.D.2 Tarek Dufan, M.D.2 Kyle Malkoske,2 Jeff Bews,2 Garry Schroeder, M.D., F.R.C.P.C.2 Patrick Cho, M.D., F.R.C.S.C.2 Darryl Drachenberg, M.D., F.R.C.S.C.2 Amit Chowdhury, M.D., F.R.C.P.C.2 1Cancer Centre of Southeastern Ontario, Kingston, ON, Canada; 2CancerCare Manitoba, Winnipeg, MB, Canada. Purpose: The incidence of extraprostatic seed migration published in the literature ranges from 5.9-18% and no pulmonary consequences have been described. The exact mechanism of embolization is still unclear, although the most prevalent theory is that the seeds migrate through the venous system to the lungs and other organs. To ensure adequate radiation dose to the prostate, seeds are often implanted immediately within or outside of the prostatic capsule. These seeds are at a higher risk for migration to the lung or other organs. The goals of this study are to document the incidence of seed embolization to the lungs after transperineal interstitial permanent prostate brachtherapy (TIPPB) and to examine the effect of extraprostatic seed placement and prostate volume on the rate of seed migration. Methods and Materials: A total of 135 patients with T1-T2 prostate cancer underwent TIPPB using 125I loose-seed technique between April 2003 and April 2007. A chest radiograph, CT and MR scans of the pelvis were obtained one month after implant. Patient and implant characteristics including volume of prostate gland and number of planned extraprostatic seeds were analyzed to examine the relationship with seed loss. Results: Seed embolization to the thorax was observed in 24 (17.7%) of 135 patients. This was attributed to the migration of only 26 (0.23%) of 11,244 total implanted seeds. Within this subset of 24 patients, a total of 34.2% of