Login to Access Video or Poster Abstract: MP84-18
Sources of Funding: None

Introduction

Rates of erectile dysfunction (ED) following the treatment of prostate cancer with radiotherapy (RT) vary. Pooled estimates of ED after RT will promote accurate patient counseling and shared decision-making. We systematically evaluated the development of ED in potent men after prostate RT.

Methods

We performed a critical review of PubMed/Medline, Embase, the Cochrane Library, and Web of Science in April 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. We identified prospective measures of ED before and after prostate RT. 278 abstracts were screened and 105 publications met the criteria for inclusion. Only men who were potent before RT were included in the analysis. We used meta-regression to determine associations with ED.

Results

In total, 17,057 men underwent brachytherapy (BT) (65%), 8,166 men underwent external beam radiation therapy (EBRT) (31%), and 1046 men underwent BT + EBRT (4%). The median follow-up time for all studies was 3 years (range 0.2-15 years). Seven common instruments were used to measure ED, with 23 different cut-offs for ED. The Sexual Health Inventory for Men (SHIM) was used in 31 studies (30%). Pooled estimates of SHIM-confirmed ED (<10-17), suggest the prevalence of ED after RT is 34% of men (95% confidence interval, CI 0.29-0.39) at 1 year, 39% (95% CI 0.33-0.44) at 2 years, 44% (95% CI 0.34-0.53) at 3 years, and 57% (95% CI 0.53-0.61) at 5.5 years. After controlling for median age in the study and percent of patients on androgen deprivation therapy, meta-regression showed that compared to BT alone, BT+EBRT increased the proportion of men with ED by 12.5% (95% CI 0.01-0.24). No differences were observed in the proportion of men with ED between studies of BT and EBRT. As the loss to follow-up increased by 10% within any of the studies, on average, the proportion of men with ED increased by 2.3% (95% CI 0.6-4.8).

Conclusions

Measurements of ED vary significantly in published series following RT. ED is common regardless of RT modality. Using the most objective measures, ED is found in approximately 50% of previously potent patients at 5 years. Loss to follow-up in studies may bias the results to overestimate ED.

Funding

None