A new study seeks to predict the chances of sexual dysfunction in patients who are treated for prostate cancer — a key question for many men facing the disease.
The study found that the odds of recovering erectile function vary widely and depend on a host of factors, including type of treatment along with the patient’s age, race, PSA level and sexual potency before treatment.
“This will make it possible for patients to have a more realistic view of what to expect for themselves, rather than trying to guess where they fit in overall compared to the average guy with prostate cancer,” study co-author Dr. Martin Sanda of Beth Israel Deaconess Medical Center in Boston told the AP.
To create their predictive tool, Sanda and colleagues analyzed data on 1,027 men with early-stage prostate cancer, between the ages of 38 and 84, from the Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment. In addition to individual characteristics of each patient, the analysis included the type of treatment the men received: surgery (either nerve-sparing or non-nerve sparing surgery), standard radiation, or radiation seeds (brachytherapy).
After a two-year follow-up, the researchers found that they were able to predict sexual function correctly in 77% of prostate-cancer patients who were treated with surgery, in 87% of patients who had standard radiation, and in 90% of the men who had brachytherapy.
The AP summed up the results this way:
For surgery, the prospects for maintaining top sexual function for a 50-year-old man could range from 21 percent to 70 percent, depending on his PSA level and whether a nerve-sparing technique was used.
For standard radiation, the study found, the odds for a man keeping top sexual function ranged from 53 percent to 92 percent depending on PSA level and whether hormones were used along with radiation. The researchers couldn’t find an age-related difference for standard radiation.
For radiation pellets, a 60-year-old man’s chances of keeping top sexual function ranged from 58 percent to 98 percent depending on race and body mass index. African-Americans and trimmer men had better chances.
One major drawback of the study is that it did not follow prostate cancer patients who engaged in watchful waiting — in which men’s slow-growing tumors are monitored but not treated unless the disease worsens — for comparison. Many men have tumors that don’t require aggressive treatment and will never become lethal.
The study also focused entirely on the most common sexual side effect of erectile dysfunction, though problems like dry ejaculation and infertility are also common among prostate cancer patients and survivors.
Further, the study looked only at early-stage patients. Not all patients in the general population may have as wide a range of treatments to choose from, depending on the stage of their disease, so the findings may be more useful for informing men about the risks of the treatment they have already chosen, rather than influencing their decision in advance.
Still, the authors say the findings should help many more men play a larger role in their own treatment decisions. “The promise of patient-centered outcomes research will be realized not only when high-quality outcomes data are available for all common medical problems but also when patients are routinely informed and invited to participate in their healthcare decisions,” wrote Dr. Michael J. Barry of Massachusetts General Hospital, who was not involved in the study, in an accompanying editorial.
The study was published in the Sept. 21 issue of the Journal of the American Medical Association.