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1.
Urology ; 135: 111-116, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31454660

RESUMO

OBJECTIVE: To explore relationships between dose to periprostatic anatomic structures and erectile dysfunction (ED) outcomes in an institutional cohort treated with prostate brachytherapy. METHODS: The Sexual Health Inventory for Men (SHIM) instrument was administered for stage cT1-T2 prostate cancer patients treated with Pd-103 brachytherapy over a 10-year interval. Dose volume histograms for regional organs at risk and periprostatic regions were calculated with and without expansions to account for contouring uncertainty. Regression tree analysis clustered patients into ED risk groups. RESULTS: We identified 115 men treated with definitive prostate brachytherapy who had 2 years of complete follow-up. On univariate analysis, the subapical region (SAR) caudal to prostate was the only defined region with dose volume histograms parameters significant for potency outcomes. Regression tree analysis separated patients into low ED risk (mean 2-year SHIM 20.03), medium ED risk (15.02), and high ED risk (5.54) groups. Among patients with good baseline function (SHIM ≥ 17), a dose ≥72.75 Gy to 20% of the SAR with 1 cm expansion was most predictive for 2-year potency outcome. On multivariate analysis, regression tree risk group remained significant for predicting potency outcomes even after adjustment for baseline SHIM and age. CONCLUSION: Dose to the SAR immediately caudal to prostate was predictive for potency outcomes in patients with good baseline function. Minimization of dose to this region may improve potency outcomes following prostate brachytherapy.


Assuntos
Braquiterapia/efeitos adversos , Disfunção Erétil/diagnóstico , Ereção Peniana/efeitos da radiação , Neoplasias da Próstata/radioterapia , Lesões por Radiação/diagnóstico , Idoso , Braquiterapia/métodos , Relação Dose-Resposta à Radiação , Disfunção Erétil/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Paládio/administração & dosagem , Paládio/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Prognóstico , Estudos Prospectivos , Próstata/patologia , Próstata/efeitos da radiação , Neoplasias da Próstata/patologia , Lesões por Radiação/etiologia , Radioisótopos/administração & dosagem , Radioisótopos/efeitos adversos , Análise Espaço-Temporal , Fatores de Tempo
2.
Int J Radiat Oncol Biol Phys ; 106(2): 291-299, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31629838

RESUMO

PURPOSE: We evaluated the use of high dose-rate-like stereotactic body radiation therapy (SBRT) retreatment for biopsy-proven local persistence in prostate postradiation therapy, evaluating efficacy and toxicity. METHODS AND MATERIALS: From 2009 to 2018, 50 patients with biopsy-proven recurrent prostate cancer >2 years after prior treatment were retreated with a high dose-rate-like dose of 3400 cGy over 5 fractions. Previous radiation therapy dose measured 75.6 Gy (64.8-81.0) and median salvage interval was 8.1 years (32-241 mo.). Eighty-three percent of patients had Gleason score 7 or higher disease at retreatment. Those with preexisting toxicity >grade 1 from their prior course were excluded. The planning target volume was comprised of the clinical target volume (prostate + any contiguous extension only) with no additional expansion. Toxicity assessment used CTCAE v.3.0 criteria. RESULTS: Median follow-up was 44 months (3-110). Median pre-SBRT salvage baseline prostate specific antigen (PSA) of 3.97 ng/mL decreased to 0.6 ng/mL and 0.16 ng/mL at 1 and 5 years in nonrelapsed patients, respectively. Actuarial 5-year biochemical disease-free survival (DFS) measured 60%, with corresponding 5-year actuarial local, distant, and salvage androgen deprivation therapy free rates of 94%, 89%, and 69%, respectively. Actuarial 5-year biochemical DFS measured 78% if PSA at salvage was <6.92 ng/mL versus 12% with ≥6.92 ng/mL (P = .0001). Toxicity was primarily in the GU domain, with an 8% 5-year actuarial rate of grade 3+, 3% when limited to salvage of "conventional external beam only" local relapse. No gastrointestinal (GI) toxicity >grade 1 occurred. Of the 30% sexually potent at the time of salvage, 82% subsequently lost potency. CONCLUSIONS: SBRT salvage of local prostate recurrence in previously irradiated patients appears clinically feasible in this challenging group. It demonstrates favorable PSA and DFS response, typically deferring the need for salvage androgen deprivation therapy or other treatment by over 5 years, with low GU and GI toxicity.


Assuntos
Recidiva Local de Neoplasia/radioterapia , Neoplasias da Próstata/radioterapia , Radiocirurgia/métodos , Reirradiação/métodos , Terapia de Salvação/métodos , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Androgênios/uso terapêutico , Biópsia , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Seguimentos , Humanos , Calicreínas/sangue , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Ereção Peniana/efeitos da radiação , Próstata , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Radiocirurgia/efeitos adversos , Reirradiação/efeitos adversos , Terapia de Salvação/efeitos adversos , Fatores de Tempo
3.
Int J Radiat Oncol Biol Phys ; 105(2): 400-409, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31175904

RESUMO

PURPOSE: To assess whether BIO 300, a synthetic genistein nanosuspension, improves the therapeutic index in prostate cancer treatment by preventing radiation-induced erectile dysfunction (ED) without reducing tumor radiosensitivity. METHODS AND MATERIALS: Male Sprague-Dawley rats were exposed to 25 Gy of 220-kV prostate-confined x-rays. Animals were randomized to receive sham radiation therapy (RT), RT alone, RT with daily BIO 300 at 2 experimental dosing regimens, or RT with daily genistein. Erectile response was evaluated over time. Penile shaft tissue was harvested for histologic analyses. Murine xenograft studies using prostate cancer cell lines determined the effects of BIO 300 dosing on RT efficacy. RESULTS: Prostate-confined RT significantly decreased apomorphine-induced erectile response (P < .05 vs sham RT). Erection frequency in animals receiving prophylactic treatment with BIO 300 starting 3 days before RT was similar to sham controls after RT. Treatment with synthetic genistein did not mitigate loss in erectile frequency. At week 14, post-RT treatment with BIO 300 resulted in significantly higher quality of erectile function compared with both the RT arm and the RT arm receiving genistein starting 3 days before irradiation (P < .05). In hormone-sensitive and insensitive prostate tumor-bearing mice, BIO 300 administration did not negatively affect radiation-induced tumor growth delay. CONCLUSIONS: BIO 300 prevents radiation-induced ED, measured by erection frequency, erectile function, and erection quality, when administered 3 days before RT and continued daily for up to 14 weeks. Data also suggest that BIO 300 administered starting 2 hours after RT mitigates radiation-induced ED. Data provide strong nonclinical evidence to support clinical translation of BIO 300 for mitigation of ED while maintaining treatment response to RT.


Assuntos
Disfunção Erétil/prevenção & controle , Genisteína/uso terapêutico , Nanopartículas/uso terapêutico , Ereção Peniana/efeitos dos fármacos , Lesões Experimentais por Radiação/complicações , Protetores contra Radiação/uso terapêutico , Animais , Pressão Sanguínea , Modelos Animais de Doenças , Drogas em Investigação/uso terapêutico , Disfunção Erétil/etiologia , Fibrose , Masculino , Camundongos , Camundongos Nus , Ereção Peniana/efeitos da radiação , Pênis/irrigação sanguínea , Pênis/patologia , Próstata/efeitos da radiação , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fluxo Sanguíneo Regional , Suspensões/uso terapêutico , Transplante Heterólogo
4.
J Urol ; 202(4): 717-724, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31042109

RESUMO

PURPOSE: Clinically significant, localized prostate cancer is currently treated with whole gland therapy. This approach is effective but associated with genitourinary and rectal side effects. Focal therapy of prostate cancer has been proposed as an alternative. The aim of this study was to determine the oncologic and functional outcomes of focal high intensity focused ultrasound therapy of prostate cancer. MATERIALS AND METHODS: In this single center, prospective study 75 men were treated between April 2014 and April 2018. Multiparametric magnetic resonance imaging and transperineal template saturation prostate biopsy were performed to localize prostate cancer, followed by focal ablation with high intensity focused ultrasound. The study primary end point was the detection of clinically significant prostate cancer, defined as Gleason score 7 or greater, at 6-month followup transperineal template saturation prostate biopsy. Genitourinary side effects were of secondary interest. RESULTS: Median patient age was 67 years (IQR 60-71) and median prostate specific antigen was 5.87 ng/ml (IQR 4.65-7.44). There were 5 low risk (6.7%) and 70 intermediate risk (93.3%) cancers. Clinically significant prostate cancer was detected in 41% of the men (95% CI 30.3-53.0) who underwent biopsy at 6 months and the median number of sampled cores was 44 (IQR 36-44). Prostate specific antigen (OR 1.17, IQR 0.49-2.85, p=0.71) and multiparametric magnetic resonance imaging (14.3% sensitivity, IQR 6.7-31.5) performed poorly to predict positive biopsies. Pad-free continence and erection sufficient for penetration were preserved in 63 of 64 (98.4%) and 31 of 45 patients (68.9%), respectively. CONCLUSIONS: Focal therapy with high intensity focused ultrasound leads to a low rate of genitourinary side effects. Followup biopsy of treated and untreated prostates remains the only modality to adequately select men in need of early salvage treatment.


Assuntos
Tratamentos com Preservação do Órgão/métodos , Próstata/patologia , Neoplasias da Próstata/terapia , Terapia por Ultrassom/métodos , Idoso , Biópsia com Agulha de Grande Calibre , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Órgãos em Risco/efeitos da radiação , Seleção de Pacientes , Ereção Peniana/efeitos da radiação , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/efeitos da radiação , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
5.
Int J Radiat Oncol Biol Phys ; 103(5): 1212-1220, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30529374

RESUMO

PURPOSE: Radiation therapy (RT) offers an important and curative approach to treating prostate cancer, but it is associated with a high incidence of erectile dysfunction (ED). It is not clear whether the etiology of radiation-induced ED (RI-ED) is driven by RT-mediated injury to the vasculature, the nerves, or both. This pilot study sought to distinguish the effects of vascular and nerve injury in RI-ED by applying a vascular radioprotectant in a rat model of prostate RT. METHODS: A single dose of the thrombopoietin mimetic (TPOm; RWJ-800088), previously shown to mitigate radiation-induced vascular injury, was administered 10 minutes after single-fraction conformal prostate RT. Nine weeks after RT, rats were assessed for erectile and arterial function. Nerve markers were quantified with reverse transcriptase polymerase chain reaction. Immunofluorescent microscopy further characterized vascular effects of RT and TPOm. RESULTS: Sham animals and animals that received RT and TPOm showed significant arterial vasodilation in response to systemic hydralazine (24.1% ± 7.3% increase; P = .03 in paired t test). However, animals that received RT and vehicle were unable to mount a vasodilatory response (-7.4% ± 9.9% increase; P = .44 in paired t test). TPOm prevented RT-induced change in the penile artery cross-sectional area (P = .036), but it did not ameliorate cavernous nerve injury as evaluated by gene expression of neuronal injury markers. Despite significant structural and functional vascular protective effects and some trends for differences in nerve injury/recovery markers, TPOm did not prevent RI-ED at 9 weeks, as assessed by intracavernous pressure monitoring after cavernous nerve stimulation. CONCLUSIONS: These data suggest that vascular protection alone is not sufficient to prevent RI-ED and that cavernous nerve injury plays a key role in RI-ED. Further research is required to delineate the multifactorial nature of RI-ED and to determine if TPOm with modified dosing regimens can mitigate against nerve injury either through direct or vascular protective effects.


Assuntos
Disfunção Erétil/prevenção & controle , Pênis/efeitos da radiação , Peptídeos/administração & dosagem , Próstata/efeitos da radiação , Protetores contra Radiação/administração & dosagem , Vasodilatação/efeitos da radiação , Animais , Artérias/diagnóstico por imagem , Artérias/efeitos dos fármacos , Modelos Animais de Doenças , Disfunção Erétil/etiologia , Hidralazina/farmacologia , Peptídeos e Proteínas de Sinalização Intercelular , Masculino , Manometria/métodos , Ereção Peniana/efeitos dos fármacos , Ereção Peniana/fisiologia , Ereção Peniana/efeitos da radiação , Pênis/irrigação sanguínea , Pênis/efeitos dos fármacos , Pênis/inervação , Projetos Piloto , Ratos , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase em Tempo Real , Fatores de Tempo , Ultrassonografia , Vasodilatação/efeitos dos fármacos , Vasodilatadores/farmacologia
6.
Int J Impot Res ; 30(4): 179-188, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29973698

RESUMO

Radiotherapy (RT) for prostate cancer (PC) can cause erectile dysfunction (ED) by damaging neurovascular structures with oxidative stress. In this study, we evaluated the effects of resveratrol, an antioxidant, on post-RT ED. Fifty rats in five groups were evaluated; control (C), prostate-confined radiotherapy with short- and long-term vehicle or resveratrol treatment. Cavernosal tissues were obtained to analyze glutathione (GSH), nitric oxide (NO), cyclic guanosine monophosphate (cGMP), 8-hydroxy-2'-deoxy-guanosine (8-OHdG) levels and superoxide dismutase (SOD), caspase-3 activities, sirtuin-1, Foxo-3, nNOS, and eNOS protein expressions. Intracavernosal pressures (ICP) were measured for the long-term treatment group. In the RT + long-term vehicle treatment group, tissue GSH, NO, cGMP, and SOD activity were decreased while 8-OHdg levels and caspase-3 activities were increased. Radiotherapy caused a decrease in sirtuin-1, nNOS, and eNOS protein expressions. These parameters were reversed by resveratrol treatment. Foxo-3 protein expressions were unaltered in the RT + short-term vehicle treatment group and started to increase as a defense mechanism in the RT + long-term vehicle group; however, resveratrol treatment caused a significant increase in Foxo-3 expressions. Resveratrol preserved the metabolic pathways involved in erectile function and provided functional protection. Resveratrol can be used as a supplementary agent in patients undergoing radiotherapy to preserve erectile function.


Assuntos
Antioxidantes/farmacologia , Disfunção Erétil/tratamento farmacológico , Óxido Nítrico Sintase Tipo III/metabolismo , Ereção Peniana/efeitos dos fármacos , Pênis/efeitos dos fármacos , Radioterapia/efeitos adversos , Resveratrol/farmacologia , Sirtuína 1/metabolismo , Animais , Disfunção Erétil/etiologia , Disfunção Erétil/metabolismo , Proteína Forkhead Box O3/metabolismo , Glutationa/metabolismo , Masculino , Óxido Nítrico , Ereção Peniana/efeitos da radiação , Pênis/metabolismo , Pênis/efeitos da radiação , Ratos , Ratos Wistar , Superóxido Dismutase/metabolismo
7.
Brachytherapy ; 17(5): 782-787, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29936129

RESUMO

PURPOSE: "Quadrella" index has been recently developed to assess oncological and functional outcomes after prostate brachytherapy (PB). We aimed to evaluate this index at 1, 2, and 3 years, using validated questionnaires, assessed prospectively. METHODS AND MATERIALS: From 08/2007 to 01/2013, 193 patients underwent 125Iodine PB for low-risk or favorable intermediate-risk prostate adenocarcinoma. Inclusion criteria were as follows: no incontinence (International Continence Society Index initial score = 0) and good erectile function (International Index of Erectile Function-5 items: >16). One hundred patients were included (mean age: 64 y). Postimplantation intake of phosphodiesterase inhibitors was not considered as failure. The "Quadrella" index was defined by the absence of biochemical recurrence (Phoenix criteria), significant erectile dysfunction (ED) (Index of Erectile Function-5 items: >16), urinary toxicity (UT) (International Prostate Score Symptom [IPSS] <15 or IPSS> 15 with ΔIPSS <5), and rectal toxicity (RT) (Radiation Therapy Oncology Group = 0). RESULTS: At 12 months, 90 patients were evaluable: 42/90 (46.7%) achieved Quadrella. The main criteria for failure were as follows: ED in 77.1% (37/48) of cases, RT in 20.8% (10/48) of cases, and UT in 12.5% (9/57) of cases. At 24 and 36 months, 59.3% (48/81) and 61.1% (44/72) of patients achieved Quadrella, respectively. The main cause of failure was ED in 69.7% (23/33) and 85.7% (24/28) of cases, while RT was involved in 21.2% (7/33) and in 3.6% (1/28) of cases, and UT in 9.1% (3/33) and 3.6% (1/28) of cases. Only one case of biochemical recurrence was observed (i.e., 1/28 = 3.6% at 3 y). CONCLUSIONS: The Quadrella can be used at 1, 2, and 3 years after PB. It allows to take into account the urinary and RT specific to PB. ED was the main cause of failure. This index will be useful to assess midterm and long-term results.


Assuntos
Adenocarcinoma/radioterapia , Braquiterapia/métodos , Disfunção Erétil/fisiopatologia , Ereção Peniana/fisiologia , Neoplasias da Próstata/radioterapia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Idoso , Disfunção Erétil/sangue , Disfunção Erétil/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Ereção Peniana/efeitos da radiação , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/complicações , Neoplasias da Próstata/diagnóstico , Reto , Inquéritos e Questionários , Fatores de Tempo
8.
Int J Urol ; 25(4): 366-371, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29397569

RESUMO

OBJECTIVES: To evaluate age-related quality of life changes in patients with localized prostate cancer treated by high-dose rate brachytherapy combined with external beam radiation therapy. METHODS: A total of 172 patients with clinically localized prostate cancer were categorized to age groups <75 years and ≥75 years. Changes in their quality of life were evaluated using the Japanese version of Medical Outcome Study 8-Items Short Form Health Survey, Expanded Prostate Cancer Index Composite and International Index of Erectile Function-5 at baseline, and followed up to 24 months after treatment. RESULTS: There were no significant differences in Medical Outcome Study 8-Items Short Form Health Survey scores, and urinary and bowel scores of the Expanded Prostate Cancer Index Composite for older men after treatment. International Index of Erectile Function-5 summary scores were significantly decreased in both groups. Although sexual function and sexual bother scores were decreased in patients aged <75 years, these scores were maintained in patients aged ≥75 years. CONCLUSIONS: Quality of life of prostate cancer patients undergoing high-dose rate brachytherapy combined with external beam radiation therapy does not seem to be significantly affected by age.


Assuntos
Braquiterapia/efeitos adversos , Ereção Peniana/efeitos da radiação , Neoplasias da Próstata/radioterapia , Qualidade de Vida , Fatores Etários , Idoso , Biópsia , Braquiterapia/métodos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Seguimentos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Gradação de Tumores , Próstata/patologia , Próstata/efeitos da radiação , Neoplasias da Próstata/patologia , Neoplasias da Próstata/psicologia , Dosagem Radioterapêutica , Resultado do Tratamento
9.
Int J Radiat Oncol Biol Phys ; 99(3): 680-688, 2017 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29280463

RESUMO

PURPOSE/OBJECTIVES: Radiation-induced erectile-dysfunction (RiED) is one of the most common side effects of radiation therapy (RT) and significantly reduces the quality of life (QoL) of cancer patients. Approximately 50% of prostate cancer patients experience RiED within 3 to 5 years after completion of RT. A series of vascular, muscular, and neurogenic injuries after prostate RT lead to RiED; however, the precise role of RT-induced neurogenic injury in RiED has not been fully established. The cavernous nerves (CN) are postganglionic parasympathetic nerves located beside the prostate gland that assist in penile erection. This study was designed to investigate the role of CN injury, tissue damage, and altered signaling pathways in an RiED rat model. METHODS AND MATERIALS: Male rats were exposed to a single dose of 25 Gy prostate-confined RT. Erectile function was evaluated by intracavernous pressure (ICP) measurements conducted both 9 and 14 weeks after RT. Neuronal injury was evaluated in the CN using quantitative polymerase chain reaction, conduction studies, transmission electron microscopy, and immunoblotting. Masson trichrome staining was performed to elucidate fibrosis level in penile tissues. RESULTS: There were significant alterations in the ICP (P<.0001) of RT rats versus non-RT rats. TEM analysis showed decreased myelination, increased microvascular damage, and progressive axonal atrophy of the CN fibers after RT. Electrophysiologic analysis showed significant impairment of the CN conduction velocity after RT. RT also significantly increased RhoA/Rho-associated protein kinase 1 (ROCK1) mRNA and protein expression. In addition, penile tissue showed increased apoptosis and fibrosis 14 weeks after RT. CONCLUSIONS: RT-induced CN injury may contribute to RiED; this is therefore a rationale for developing novel therapeutic strategies to mitigate CN and tissue damage. Moreover, further investigation of the RhoA/ROCK pathway's role in mitigating RiED is necessary.


Assuntos
Disfunção Erétil/etiologia , Fibras Parassimpáticas Pós-Ganglionares/efeitos da radiação , Próstata/inervação , Lesões Experimentais por Radiação/complicações , Animais , Modelos Animais de Doenças , Disfunção Erétil/fisiopatologia , Masculino , Condução Nervosa/fisiologia , Fibras Parassimpáticas Pós-Ganglionares/fisiopatologia , Ereção Peniana/fisiologia , Ereção Peniana/efeitos da radiação , Pênis/inervação , Pênis/patologia , Pênis/efeitos da radiação , Lesões Experimentais por Radiação/fisiopatologia , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Coloração e Rotulagem
10.
Lasers Med Sci ; 32(7): 1517-1523, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28685201

RESUMO

This study aimed to evaluate the impact of thulium:yttrium-aluminum-garnet (Tm:YAG) (RevoLix®) laser prostatectomy for the treatment of benign prostatic obstructions on erectile function (EF). A total of 208 patients who underwent Tm:YAG laser prostatectomies participated in this study. All cases were evaluated preoperatively and at 3, 6, and 12 months postoperatively using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, and the International Index of Erectile Function (IIEF-5) questionnaires. Patients were divided into groups A (severe erectile dysfunction [ED]), B (moderate ED), and C (mild-to-normal ED), according to their IIEF-5 scores. The median patient ages were 69, 65, and 62 years in groups A, B, and C, respectively. Significant improvements occurred in the IPSS and QoL score within the groups during the 12-month follow-up period. The IIEF-5 scores at 3 months postoperatively were lower than the preoperative scores in groups B and C. The IIEF-5 scores subsequently improved during the 12-month follow-up period. The slope of the relationship between the IIEF-5 score and the time since Tm:YAG laser prostatectomy had a ß value of 0.2210 (95% confidence interval 0.103 to 0.338, p = 0.0003); hence, each postoperative month was associated with an increase of 0.2210 in the IIEF-5 score. The IIEF-5 scores gradually increased and reached the preoperative levels by the 12-month follow-up assessment. Although the IIEF-5 score dropped significantly during the first 3 months postoperatively, it improved over the following 12 months. Tm:YAG laser prostatectomy did not impact on EF ultimately.


Assuntos
Lasers de Estado Sólido/uso terapêutico , Ereção Peniana/efeitos da radiação , Prostatectomia , Hiperplasia Prostática/fisiopatologia , Hiperplasia Prostática/cirurgia , Túlio/química , Idoso , Seguimentos , Humanos , Terapia a Laser , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Resultado do Tratamento
11.
J Sex Med ; 14(7): 891-897, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28673433

RESUMO

BACKGROUND: Although several reports have documented the subjective improvement of erectile function after low-intensity extracorporeal shockwave therapy (LI-ESWT) in patients with vasculogenic erectile dysfunction (ED), objective assessment data of penile hemodynamics are lacking. AIM: To assess penile hemodynamics before and 3 months after LI-ESWT in a group of patients with documented vasculogenic ED. METHODS: This was a double-blinded, randomized, sham-controlled trial. Forty-six patients with ED were randomized; 30 underwent LI-ESWT and 16 had a sham procedure in double-blinded fashion. All patients underwent penile triplex ultrasonography by the same investigator immediately before and 3 months after treatment. Patient demographics, International Index of Erectile Function erectile function domain (IIEF-ED) score, and minimal clinically important difference were assessed at baseline and 1, 3, 6, 9, and 12 months after treatment. OUTCOMES: Changes in peak systolic velocity and resistance index as measured by triplex ultrasonography at baseline and 3 months after treatment were the main outcomes of the study. Secondary outcomes were changes in the IIEF-EF score from baseline to 1, 3, 6, 9, and 12 months after treatment and the percentage of patients reaching a minimal clinically important difference during the same period for the two groups. RESULTS: IIEF-EF minimal clinically important differences for the active vs sham group were observed for 56.7% vs 12.5% (P = .005) at 1 month, 56.7% vs 12.5% (P = .003) at 3 months, 63.3% vs 18.8% (P = .006) at 6 months, 66.7% vs 31.3% (P = .022) at 9 months, and 75% vs 25% (P = .008) at 12 months. Mean peak systolic velocity increased by 4.5 and 0.6 cm/s in the LI-ESWT and sham groups, respectively (P < .001). CLINICAL IMPLICATIONS: Such results offer objective and subjective documentation of the value of this novel treatment modality for men with vasculogenic ED. STRENGTHS AND LIMITATIONS: Strengths include the prospective, randomized, sham-controlled type of study and the assessment of penile hemodynamics. Limitations include the small sample and strict inclusion criteria that do not reflect everyday clinical practice. CONCLUSION: The present study confirms the beneficial effect of LI-ESWT on penile hemodynamics and the beneficial effect of this treatment up to 12 months. Kalyvianakis D, Hatzichristou D. Low-Intensity Shockwave Therapy Improves Hemodynamic Parameters in Patients With Vasculogenic Erectile Dysfunction: A Triplex Ultrasonography-Based Sham-Controlled Trial. J Sex Med 2017;14:891-897.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/métodos , Ondas de Choque de Alta Energia/uso terapêutico , Impotência Vasculogênica/terapia , Pênis/fisiopatologia , Hemodinâmica , Humanos , Impotência Vasculogênica/diagnóstico por imagem , Impotência Vasculogênica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ereção Peniana/efeitos da radiação , Pênis/irrigação sanguínea , Pênis/efeitos da radiação , Estudos Prospectivos , Ondas Ultrassônicas , Ultrassonografia
12.
Int J Radiat Oncol Biol Phys ; 98(2): 304-317, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28463150

RESUMO

PURPOSE: The long-term effects of neoadjuvant androgen deprivation therapy (NADT) with radiation therapy on participant-reported health-related quality of life (HRQOL) have not been characterized in prospective multicenter studies. We evaluated HRQOL for 2 years among participants undergoing radiation therapy (RT) with or without NADT for newly diagnosed, early-stage prostate cancer. METHODS AND MATERIALS: We analyzed longitudinal cohort data from the Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment Consortium to ascertain the HRQOL trajectory of men receiving NADT with external beam RT (EBRT) or brachytherapy. HRQOL was measured using the expanded prostate cancer index composite 26-item questionnaire at 2, 6, 12, and 24 months after the initiation of NADT. We used the χ2 or Fisher exact test to compare the shift in percentages between groups that did or did not receive NADT. Analyses were conducted at the 2-sided 5% significance level. RESULTS: For subjects receiving EBRT, questions regarding the ability to have an erection, ability to reach an orgasm, quality of erections, frequency of erections, ability to function sexually, and lack of energy were in a significantly worse dichotomized category for the patients receiving NADT. Comparing the baseline versus 24-month outcomes, 24%, 23%, and 30% of participants receiving EBRT plus NADT shifted to the worse dichotomized category for the ability to reach an orgasm, quality of erections, and ability to function sexually compared with 14%, 13%, and 16% in the EBRT group, respectively. CONCLUSIONS: Compared with baseline, at 2 years, participants receiving NADT plus EBRT compared with EBRT alone had worse HRQOL, as measured by the ability to reach orgasm, quality of erections, and ability to function sexually. However, no difference was found in the ability to have an erection, frequency of erections, overall sexual function, hot flashes, breast tenderness/enlargement, depression, lack of energy, or change in body weight. The improved survival in intermediate- and high-risk patients receiving NADT and EBRT necessitates pretreatment counseling of the HRQOL effect of NADT and EBRT.


Assuntos
Antagonistas de Androgênios/efeitos adversos , Braquiterapia/efeitos adversos , Terapia Neoadjuvante/efeitos adversos , Orgasmo , Ereção Peniana , Neoplasias da Próstata/terapia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Androgênios/uso terapêutico , Peso Corporal/efeitos dos fármacos , Peso Corporal/efeitos da radiação , Braquiterapia/métodos , Braquiterapia/estatística & dados numéricos , Mama/efeitos dos fármacos , Mama/efeitos da radiação , Distribuição de Qui-Quadrado , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Terapia Combinada/estatística & dados numéricos , Depressão/etiologia , Disfunção Erétil/etiologia , Fadiga/etiologia , Fogachos/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Terapia Neoadjuvante/estatística & dados numéricos , Orgasmo/efeitos dos fármacos , Orgasmo/efeitos da radiação , Ereção Peniana/efeitos dos fármacos , Ereção Peniana/efeitos da radiação , Estudos Prospectivos , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Inquéritos e Questionários , Fatores de Tempo
13.
Int J Urol ; 24(7): 518-524, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28455847

RESUMO

OBJECTIVES: To evaluate male sexual function in Japanese prostate cancer patients undergoing permanent brachytherapy without endocrine treatment, using quality of life measures of the Expanded Prostate Cancer Index Composite. METHODS: A total of 482 patients were selected as analysis subjects from the nationwide database for the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation. The patients were asked to complete the Expanded Prostate Cancer Index Composite questionnaires before and at 3, 12, 24, and 36 months after the permanent brachytherapy. Changes in their responses were analyzed, and any association of the outcomes was investigated. Furthermore, changes over time in their answers to Q18 (usual quality of your erections) were analyzed. RESULTS: A total of 72 patients (14.9%) had received external beam radiation. A total of 68 patients (14.1%) had taken any 5-phosphodiesterase inhibitor medications. Regarding Q18, 232 patients (48.2%) selected either "There was no sexual activity" or "There was no desire for erection" before receiving permanent brachytherapy. Of all the 482 patients, sexual function was preserved in 138 patients (28.7%) 3 years after permanent brachytherapy. Overall satisfaction has significantly improved without regard for the deterioration of sexual function. Significant factors for maintaining sexual activity were patient age and sexual activity before permanent brachytherapy. CONCLUSIONS: In Japanese patients undergoing permanent brachytherapy alone for prostate cancer, the sexual function is not well preserved. However, decreased sexual function does not seem to represent a major factor determining patients' overall satisfaction. These findings might be peculiar to Japanese patients, in whom elderly subjects account for the majority.


Assuntos
Braquiterapia/efeitos adversos , Radioisótopos do Iodo/administração & dosagem , Ereção Peniana/efeitos da radiação , Neoplasias da Próstata/radioterapia , Comportamento Sexual/efeitos da radiação , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/métodos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Humanos , Radioisótopos do Iodo/efeitos adversos , Japão , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Inibidores da Fosfodiesterase 5/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Qualidade de Vida , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Resultado do Tratamento
14.
J Sex Med ; 14(4): 558-565, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28258954

RESUMO

INTRODUCTION: Changes in sexual function other than erectile dysfunction are sparsely investigated after radiation therapy for prostate cancer. AIM: To investigate orgasmic dysfunction, urinary incontinence during sexual activity, changes in penile morphology, and sensory disturbances in the penis in patients with prostate cancer treated with external-beam radiation therapy (EBRT). METHODS: In February 2015, men treated with EBRT at our center 3 months to 5 years previously (N = 519) received a study-specific questionnaire. This was developed from purpose-built questions and validated tools including the Erection Hardness Scale. All patients had received a radiation dose of 78 Gy. Androgen deprivation therapy was administered according to disease characteristics. MAIN OUTCOME MEASURES: Outcome measurements were prevalence rates and predictors of these side effects as identified by multivariate logistic regression analyses. RESULTS: One hundred nine patients were eligible (sexually active and had completed androgen deprivation therapy) for inclusion. Twenty-four percent reported anorgasmia, 44% reported a decreased intensity of their orgasms, and 40% reported that the time it took to reach orgasm had increased. Eleven percent reported anejaculation. Fifteen percent reported orgasm-associated pain. Only 4% reported urinary incontinence during sexual activity. Subjective penile length loss in excess of 1 cm was reported by 42%. Twelve percent reported an altered curvature of their penis after EBRT. Six percent reported painful erections. Twenty-seven percent reported decreased sensitivity in the penis after EBRT, 2% reported a cold sensation, and 2% reported paresthesia. Increasing time since final treatment increased the risk of penile sensory disturbances (odds ratio = 1.05; P = .028). CONCLUSION: Orgasmic dysfunction, changes in penile morphology, and sensory disturbances in the penis are common side effects of ERBT. Patients should be properly informed of the occurrence of these side effects before deciding which treatment to pursue. Frey A, Pedersen C, Lindberg H, et al. Prevalence and Predicting Factors for Commonly Neglected Sexual Side Effects to External-Beam Radiation Therapy for Prostate Cancer. J Sex Med 2017;14:558-565.


Assuntos
Disfunção Erétil/etiologia , Ereção Peniana/efeitos da radiação , Prostatectomia/efeitos adversos , Neoplasias da Próstata/radioterapia , Lesões por Radiação/etiologia , Idoso , Estudos Transversais , Relação Dose-Resposta à Radiação , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/efeitos da radiação , Prevalência , Lesões por Radiação/diagnóstico , Comportamento Sexual , Inquéritos e Questionários , Incontinência Urinária
15.
J Sex Med ; 13(11): 1695-1703, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27665195

RESUMO

INTRODUCTION: Hypofractionated radiotherapy could increase the radiobiological tumor dose for localized prostate cancer. The effects of hypofractionation on sexual function are not well known. AIM: To compare sexual function in patients with prostate cancer treated with 78 Gy in 39 fractions of 2 Gy or 64.6 Gy in 19 fractions of 3.4 Gy. METHODS: In total, 820 men with intermediate- to high-risk T1b-T4NX-0MX-0 prostate cancer were enrolled in the phase III HYPRO trial (2007-2010) and randomized to conventional fractionation (39 × 2 Gy) or hypofractionation (19 × 3.4 Gy). Sexual function was assessed at baseline and at 6, 12, 24, and 36 months after treatment using the International Index of Erectile Function (IIEF). For this analysis, patients (n = 322) with a baseline assessment, at least one follow-up assessment, and no or short-term (6-month) androgen-deprivation therapy were included. MAIN OUTCOME MEASURES: Mean IIEF domain scores were compared between treatments in the total population and the hormone-naïve population (n = 197) using the independent t-test. Incidences of severe erectile dysfunction (domain score < 11) at last follow-up were calculated in patients with partial or full baseline function. Binary logistic regression analyses were applied to calculate the odds ratio of hypofractionation vs conventional fractionation and to adjust for clinical factors. RESULTS: Median age was 71 years (interquartile range = 67-71) and median follow-up was 37 months (interquartile range = 25-38). Androgen-deprivation therapy was prescribed in 125 (39%). IIEF domain scores decreased after treatment but were comparable between treatment arms at baseline and during follow-up. Orgasmic function scores in hormone-naïve patients were significantly higher at 3 years after hypofractionation (4.08 vs 2.65, P = .031). In patients (n = 120) with partial or full baseline erectile function, the incidence of erectile dysfunction at last follow-up was 34.4% for hypofractionated treatment vs 39.3% for conventional treatment (adjusted odds ratio = 0.84, 95% CI = 0.37-1.90, P = .67). CONCLUSION: No significant differences in erectile functioning between conventional and hypofractionated radiotherapy were found. Hormone-naïve patients reported significantly higher orgasmic function scores at 3 years after hypofractionation.


Assuntos
Disfunção Erétil/etiologia , Neoplasias da Próstata/radioterapia , Idoso , Antagonistas de Androgênios/uso terapêutico , Fracionamento da Dose de Radiação , Humanos , Incidência , Libido , Masculino , Orgasmo/fisiologia , Ereção Peniana/efeitos da radiação , Satisfação Pessoal , Neoplasias da Próstata/complicações , Neoplasias da Próstata/tratamento farmacológico
16.
Radiother Oncol ; 118(1): 99-104, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26755165

RESUMO

OBJECTIVE: This multi-institutional phase I/II trial explored patient-assessed tolerance of increasingly hypofractionated (HPFX) radiation for low/intermediate risk prostate cancer. METHODS: 347 patients enrolled from 2002 to 2010. Three increasing dose-per-fraction schedules of 64.7 Gy/22 fx, 58.08 Gy/16 fx and 51.6 Gy/12 fx were each designed to yield equivalent predicted late toxicity. Three quality of life (QoL) surveys were administered prior to treatment and annually upto 3 years. RESULTS: Bowel QoL data at 3years revealed no significant difference among regimens (p=0.469). Bowel QoL for all regimens declined transiently, largely recovering by three years, with only the 22 fraction decrement reaching significance. Bladder outcomes at 3 years were comparable (p=0.343) although, for all patients combined, a significant decline was observed from the baseline (p=0.008). Spitzer quality of life data revealed similarly excellent, 3-year means (p=0.188). International erectile function data also revealed no significant differences at 3 years although all measures except intercourse satisfaction worsened post-treatment. CONCLUSIONS: Three-year QoL changes for bowel, bladder and SQLI were modest and similar for 3 HPFX regimens spanning 2.94-4.3 Gy per fraction. These favorable patient-scored outcomes demonstrate the safety and tolerability of such regimens and may be leveraged to support further implementation of mild to moderately hypofractionated radiotherapy in the setting of low and intermediate-risk prostate cancer.


Assuntos
Neoplasias da Próstata/radioterapia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Humanos , Intestinos/efeitos da radiação , Masculino , Pessoa de Meia-Idade , Ereção Peniana/efeitos da radiação , Hipofracionamento da Dose de Radiação , Dosagem Radioterapêutica , Inquéritos e Questionários , Bexiga Urinária/efeitos da radiação
17.
Cancer ; 121(14): 2422-30, 2015 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-25847819

RESUMO

BACKGROUND: The authors analyzed a preliminary report of patient-reported outcomes (PROs) among men who received high-dose radiation therapy (RT) on Radiation Therapy Oncology Group study 0126 (a phase 3 dose-escalation trial) with either 3-dimensional conformal RT (3D-CRT) or intensity-modulated RT (IMRT). METHODS: Patients in the 3D-CRT group received 55.8 gray (Gy) to the prostate and proximal seminal vesicles and were allowed an optional field reduction; then, they received 23.4 Gy to the prostate only. Patients in the IMRT group received 79.2 Gy to the prostate and proximal seminal vesicles. PROs were assessed at 0 months (baseline), 3 months, 6 months, 12 months, and 24 months and included bladder and bowel function assessed with the Functional Alterations due to Changes in Elimination (FACE) instrument and erectile function assessed with the International Index of Erectile Function (IIEF). Analyses included the patients who completed all data at baseline and for at least 1 follow-up assessment, and the results were compared with an imputed data set. RESULTS: Of 763 patients who were randomized to the 79.2-Gy arm, 551 patients and 595 patients who responded to the FACE instrument and 505 patients and 577 patients who responded to the IIEF were included in the completed and imputed analyses, respectively. There were no significant differences between modalities for any of the FACE or IIEF subscale scores or total scores at any time point for either the completed data set or the imputed data set. CONCLUSIONS: Despite significant reductions in dose and volume to normal structures using IMRT, this robust analysis of 3D-CRT and IMRT demonstrated no difference in patient-reported bowel, bladder, or sexual functions for similar doses delivered to the prostate and proximal seminal vesicles with IMRT compared with 3D-CRT delivered either to the prostate and proximal seminal vesicles or to the prostate alone.


Assuntos
Neoplasias da Próstata/radioterapia , Radioterapia Conformacional , Radioterapia de Intensidade Modulada , Idoso , Idoso de 80 Anos ou mais , Disfunção Erétil/etiologia , Humanos , Imageamento Tridimensional , Incidência , Intestinos/fisiopatologia , Intestinos/efeitos da radiação , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Ereção Peniana/efeitos da radiação , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Bexiga Urinária/efeitos da radiação , Transtornos Urinários/etiologia
18.
Brachytherapy ; 14(2): 160-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25255712

RESUMO

PURPOSE: To prospectively determine sexual function, bother, and potency preservation in men treated with prostate brachytherapy and twice-weekly tadalafil. METHODS AND MATERIALS: From 2005 to 2011, men treated with low-dose-rate prostate brachytherapy were treated on a prospective registration study. All patients were prescribed tadalafil 10mg twice weekly. The expanded prostate cancer index composite questionnaire was administered before treatment and at each followup. A subgroup analysis of men with sexual potency at baseline was performed. RESULTS: A total of 237 men were analyzed. Median age was 64 years (range, 44-86). Median followup was 24.8 months (range, 1-60). At baseline, 175 men (74%) reported erections firm enough for sexual activity and 148 (62%) were potent (erections firm enough for intercourse). Statistically significant changes in sexual function/bother were appreciated from baseline throughout the analysis period, although absolute changes were relatively small and did not meet criteria for clinical significance. At 24-months followup, 72% reported erections firm enough for sexual activity and 56% were potent. Of men with potency at baseline, 89% had erections firm enough for sexual activity and 76% remained potent 24 months after treatment. CONCLUSIONS: Peri-procedural tadalafil and prostate brachytherapy resulted in high rates of sexual potency preservation and no clinically significant effect on sexual quality of life.


Assuntos
Braquiterapia/efeitos adversos , Carbolinas/uso terapêutico , Disfunção Erétil/etiologia , Inibidores da Fosfodiesterase 5/uso terapêutico , Neoplasias da Próstata/radioterapia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/métodos , Carbolinas/administração & dosagem , Esquema de Medicação , Disfunção Erétil/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana/efeitos da radiação , Inibidores da Fosfodiesterase 5/administração & dosagem , Estudos Prospectivos , Neoplasias da Próstata/reabilitação , Lesões por Radiação/etiologia , Inquéritos e Questionários , Tadalafila
19.
J Sex Med ; 12(1): 210-8, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25370897

RESUMO

INTRODUCTION: Orchiectomy followed by infradiaphragmatic radiotherapy is a common treatment for stage I-II testicular seminoma. Long-term effects of orchiectomy and radiotherapy for testicular seminomas on body image and sexual function have been reported; however, few data are available on short-term effects. Patients are usually of reproductive age and sexually active; therefore, short-term effects on body image and sexual function should also be studied. AIMS: To prospectively evaluate short-term effects of orchiectomy and radiotherapy on body image and sexual function in testicular seminoma patients. METHODS: Questionnaires on body image and sexual function were prospectively distributed to all testicular seminoma patients treated between 1999 and 2013. The questionnaire distributed prior to radiotherapy was returned by 161 patients; 133 (82%) returned the second after 3 months, and 120 (75%) completed the questionnaire after 6 months. MAIN OUTCOME MEASURES: Body image and sexual function as assessed by a Dutch questionnaire on body image and sexuality after radiotherapy and orchiectomy. RESULTS: Median age was 36 years (range 18-70). After orchiectomy, 48% expressed fertility concerns, and 61% reported their body had changed. Six months after treatment, erectile rigidity was significantly decreased compared with prior to radiotherapy (P = 0.016), and 23% reported decreased sexual interest, activity, and pleasure. Changes in body image were significantly associated with decreased sexual interest, pleasure, and erectile function. Even though 45% reported that treatment negatively affected their sexual life, the number of sexually active patients remained stable at 91%. [Correction added on 12 November 2014, after first online publication: 'prior radiotherapy' was corrected to 'prior to radiotherapy'.] CONCLUSIONS: Short-term effects of treatment included fertility concerns and changes in body image. Reported erectile rigidity was significantly decreased after 6 months, as were sexual interest, activity, and pleasure. Disease and treatment had negative effects on sexual life, and changes in body image were associated with sexual dysfunction. Therefore, body image and sexual functioning should be addressed at an early stage in order to offer adequate treatment and counseling.


Assuntos
Imagem Corporal/psicologia , Neoplasias Embrionárias de Células Germinativas/radioterapia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Orquiectomia/efeitos adversos , Seminoma/radioterapia , Seminoma/cirurgia , Comportamento Sexual/psicologia , Neoplasias Testiculares/radioterapia , Neoplasias Testiculares/cirurgia , Adulto , Idoso , Humanos , Libido/efeitos da radiação , Masculino , Países Baixos , Orquiectomia/psicologia , Ereção Peniana/efeitos da radiação , Estudos Prospectivos , Qualidade de Vida , Sexualidade , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Radiother Oncol ; 112(1): 72-6, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25086852

RESUMO

BACKGROUND AND PURPOSE: Erectile function (EF) is commonly affected following prostate cancer treatment. We aim to evaluate the long-term EF following seed brachytherapy (BT) treatment. MATERIALS AND METHODS: The study consisted of 366 patients treated with BT at our institution, who completed the IIEF-5 questionnaire and reported no or mild erectile dysfunction (ED) pre-BT. The probability of EF preservation post-BT was estimated using the Kaplan-Meier methods. The difference in EF preservation by patient-, tumour- and treatment-related factors was assessed using the log-rank test. Multivariate Cox regression was used to estimate the effect of each factor on EF preservation. RESULTS: Of the 366 patients, 277 (76%) reported normal EF, and 89 (24%) reported mild ED. The patients were followed-up for a median of 41 months (range: 3-124), and the 5-year actuarial rate of EF preservation was 59%. Age at BT seed implant, presence of medical comorbidities, Gleason score and the biologically effective dose (BED) are associated with EF preservation (P < 0.005). The association for these four factors remains statistically significant in multivariate analysis, with Gleason score having the strongest effect (HR = 3.7; 95% CI = 2.6-5.4). CONCLUSION: The 5-year actuarial rate of EF preservation post-BT in our cohort is 59%, and is influenced by multiple factors.


Assuntos
Braquiterapia/efeitos adversos , Disfunção Erétil/etiologia , Neoplasias da Próstata/radioterapia , Lesões por Radiação/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Disfunção Erétil/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ereção Peniana/fisiologia , Ereção Peniana/efeitos da radiação , Inibidores da Fosfodiesterase 5/uso terapêutico , Modelos de Riscos Proporcionais , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários
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