Erectile Dysfunction as a Complication After Treatment of Prostate Cancer
Treatment of localized prostate cancer refers to two basic modes which are the radical retro pubic prostatectomy and external radiotherapy. However, according to most authors, radical prostatectomy is the gold standard for long-term survival. Objective: To determine the occurrence of erectile dysfunction after radical operative treatment and irradiation therapy.
Material and methods:
In this paper we have examined the occurrence of erectile dysfunction after conducted treatment for localized prostate cancer. In this paper we have examined 84 of 138 patients who underwent radical retro pubic prostatectomy at the Urology Clinic in the period from January 2009 to December 2010 and 26 patients who underwent radical external radiotherapy in the same period, because of localized prostate cancer. Results: The average age of surgical patients was 65 years, the youngest patient was 49 years and the oldest 81 years. From the 84 patients which underwent surgery, neurovascular preservation of nerve bundles was done in 36 (42.8%) patients from which bilateral in 28 patients (77.7%) and unilateral in 8 patients (22.2%). Average age of patients who underwent irradiation therapy was 68 years.
Erectile dysfunction occurs in greater proportion after radical retro pubic prostatectomy compared to radiation treatment, and the preservation of both neurovascular bundles reduces this difference.
Prostate cancer is nowadays one of the most common cancers of men (1, 2, 3, 4). The use of prostate specific antigen (PSA) screening, enabled the detection of a large number of patients in early stage of localized cancer (5, 6). Patients with localized prostate cancer undergo either radical prostatectomy or radiotherapy. Both treatment options have side effects. First of all, these are usually micturition disorder, i.e. urinary incontinence and erectile dysfunction. These unwanted effects reduce the quality of life in cancer patients. Today, with early detection of prostate cancer, increasing is the number of treated patients also with longer survival, and to the quality of life is given more prominence. Erectile dysfunction after surgery occurs primarily due to neurogenic damage and to a lesser extent due to vascular damage. In most patients the cause of erectile dysfunction after external radiation therapy is of vascular nature. Disorders of sexual function after treatment of prostate cancer includes both organic and psychogenic factor because the diagnosis of cancer can lead to anxiety and depression.
2. PATIENTS AND METHODS
In this paper we have examined the occurrence of erectile dysfunction after therapy carried out for localized prostate cancer. In this paper we have examined 84 of 138 patients who underwent radical retro pubic prostatectomy at the Urology clinic in the period from January 2009 to December 2010 and 26 patients who underwent radical external radiotherapy in the same period, because of localized prostate cancer. Choice of treatment depended on the patient’s age and general condition, primarily cardiovascular comorbidity. In the same two-year period, 68 patients were subjected surgical castration and transurethral resection (TUR) of the prostate due to advanced prostate cancer.
Patients filled out a questionnaire for an international index of erectile function before the treatment and 6 months after the treatment (International Index of Erectile Function (IIEF5) questionnaire). Included were patients who were and were not taken after treatment medications for improving sexual function. From the study are excluded patients who were not followed for a given period of the study, and patients who preoperatively did not have a preserved sexual function. Data were collected from medical history and data on patient age, PSA before treatment, other diseases, tumor stage and grade, smoking. Both groups of patients have been compared to data from the history of the disease using the X2 test.
In the study were examined 84 of 138 patients who had undergone radical retro pubic prostatectomy and 26 patients who were treated with radiotherapy during the same period. The average age of surgical patients was 65 years, the youngest patient was 49 years and the oldest 81 years.
The average age of patients treated with radiation therapy was 68 years. These data show that patients who underwent radiotherapy were older which is associated with poorer sexual function and more frequent cardiovascular and other diseases. Calculated mean TPSA before treatment in a group surgical patients was 6.947ng/ml (TPSA values ranged from 1.026 to 26.051 ng/ml). In the group of patients with localized prostate cancer who underwent irradiation the calculated the mean TPSA was 7.3 ng/ml Of 84 patients underwent surgery, preservation of neurovascular bundles was done in 36 (42.8%) patients from which bilateral in 28 patients (77.7%) and unilateral in 8 patients (22.2%).
Sexual function after the treatment in patients treated with radiotherapy was significantly better compared to patients who were surgically treated.In the case of bilateral nerve sparing surgery, erectile function was preserved in 16 patients (57.1%). In the case of unilateral preservation the erectile function was preserved in 3 patients (37.5%).
When examined 26 patients with localized prostate cancer who had prior treatment had preserved sexual function and who underwent radiotherapy, sexual function was preserved in 19 (73%).
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