Abstract: PD69-07
Sources of Funding: None

Introduction

The combination of radical prostatectomy (RP), radiation therapy (RT) and androgen deprivation therapy (ADT) - triple therapy (TT) is reserved for prostate cancer patients of extremely high risk or with PSA recurrence after primary therapy. The combination of these 3 treatments has a significant negative impact upon sexual function. This analysis was conducted to define the effect of TT on long-term erectile function (EF).

Methods

Study population consisted of patients who (i) were exposed to TT (in any order) (ii) had baseline EF assessed by erection hardness score (EHS) (iii) were at least 6 months after completion of ADT (iv) had an early morning serum total testosterone level ≥6 months (m) after ADT completion and (v) had erectile function assessed (EHS, IIEF) at last follow-up visit. At ≥6m after ADT cessation, patients used maximum dose PDE5 inhibitor (PDE5i) on 4 occasions. If they failed they moved directly to penile injection therapy. Injection therapy was deemed to have failed if patients had been titrated to 100 units of trimix (papaverine/phentolamine/PGE1) without success. Multivariable analysis was performed to define predictors of penetration hardness erections with penile injections. Factors analyzed in the model included: patient age, baseline EF, ADT duration, nerve sparing status at RP and end-of-treatment (EOT) total testosterone

Results

436 men met the inclusion criteria. Mean age 68±11 years. Gleason scores: 7 68%, 8 19%, 9 13%. Nerve sparing status at RP: unilateral 12%, non-nerve sparing 88%. RT modality: 3D-conformal 17%, IMRT 51%, brachytherapy 32%. Baseline median EHS score was 3, with 7% grade 2 64% grade 3, 29% grade 4. Mean ADT duration was 9±11 (4-28) months. Mean duration at last visit since cessation of ADT (last dose plus wash-out period) was 9±5 months. Mean total testosterone level at last visit 262±317 (86-742 ng/dl). 6% of men responded to PDE5i while only 49% responded to penile injections. At EOT on injections: median EHS was 2 with no patient achieving a grade 4 erection; mean IIEF EFD score was 14±9 (4-24). Predictors of injection response are listed in the Table.

Conclusions

Triple therapy for prostate cancer has a devastating effect on erectile function with more than half of the patients failing to respond to penile injection therapy.

Funding

None