Looking at a subset of patients who had erectile function prior to their procedures, the researchers found that 40% of the men who had their prostates removed reported recovery of sexual function by two years after surgery. But 58% of men who underwent external radiation and 63% of men who had brachytherapy were able to maintain functional erections at the two-year point.
With each option, younger age, fewer co-morbid conditions, lower prostate specific antigen (PSA) levels and lower cancer severity were associated with greater probability of erectile function.
In a Beth Israel statement, Sanda said, "There doesn't need to be a black box of uncertainty when it comes to predicting treatment outcomes. Each patient deserves to understand the expectations for his specific situation so that treatment decisions can be tailored to his individual circumstance."
In a related editorial, Michael Barry, MD, of Massachusetts General Hospital and the Foundation for Informed Medical Decision Making, wrote that the erectile function study helps patients who are likely to survive their disease, and for whom quality of life after treatment is an increasing concern.
"Erectile dysfunction is a common adverse effect (from prostate cancer treatment) many men care about," Barry wrote. "Consider a 60-year-old African American man with a prostate-specific antigen level of 6 ng/mL, a body mass index of 30, and a baseline sexual health-related quality of life score of 83, indicating some sexual dysfunction as well as a tumor Gleason score sum of 6 (3+3).
"This man could learn that men like him would have about a 1 in 3 chance of maintaining erectile function after radical prostatectomy if a nerve-sparing operation could be performed but a 1 in 7 chance without it."