Prediction models offer clue to erectile function after prostate treatment
Stratifying patients by pretreatment characteristics and treatment details can help clinicians predict what a man's level of erectile function will be 2 years after prostatectomy, external radiotherapy, or brachytherapy for prostate cancer, according to a study recently published in JAMA (2011;306:1205-1214).
The researchers explain that health-related quality of life outcomes (HRQoL), including that of sexual function, have emerged as a major emphasis in treatment decisions regarding prostate cancer, as most patients survive early-stage disease. Sexual dysfunction in previously potent men is commonly impaired by treatment.
To determine whether a man's sexual outcomes after the most common treatments for early-stage prostate cancer can be predicted accurately based on baseline characteristics and treatment plans, Mehrdad Alemozaffar, MD, of Beth Israel Deaconess Medical Center and Harvard Medical School, both in Boston, Massachusetts, and colleagues developed erectile-dysfunction prediction models based on the sexual outcomes of 1,027 men whose HRQoL was measured pretreatment and who were followed for 2 years after prostatectomy, external radiotherapy, or brachytherapy for prostate cancer. The models were externally validated among 1,913 patients in a cohort of men enrolled in the community-based Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) study.
Pretreatment sexual HRQoL score, age, serum prostate-specific antigen (PSA) level, race/ethnicity, body mass index, and intended treatment details were associated with functional erections 2 years after treatment. Statistical models estimated 2-year erectile function probabilities from as low as 10% or less to as high as 70% or greater, depending on the man's pretreatment patient characteristics and treatment details. The models performed well in predicting erections in the external validation among the CaPSURE cohorts.
The authors suggested that these clinically applicable models may help clinicians and patients set individualized expectations regarding prospects for erectile function in the years following primary treatment for prostate cancer.