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Patricia E. Daly, Mary T. Dunne, Carmel M. O’Shea, Marie A. Finn, John G. Armstrong

The effect of short term neo-adjuvant androgen deprivation on erectile function in patients treated with external beam radiotherapy for localised prostate cancer: An analysis of the 4- versus 8-month randomised trial.

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Patricia E. Daly, Mary T. Dunne, Carmel M. O’Shea, Marie A. Finn, John G. Armstrong

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  1. The effect of short term neo-adjuvant androgen deprivation on erectile function in patients treated with external beam radiotherapy for localised prostate cancer: An analysis of the 4- versus 8-month randomised trial Patricia E. Daly, Mary T. Dunne, Carmel M. O’Shea, Marie A. Finn, John G. Armstrong

  2. Abstract • Erectile dysfunction is a common consequence of external beam radiotherapy (EBRT) for prostate cancer. The addition of neo-adjuvant androgen deprivation (NAD) has an indeterminate additive effect. We examined the long-term effect on erectile function (EF) of two durations (4 months: arm 1 and 8 months: arm 2) of NAD prior to radiation (RT) for patients with localised prostate cancer

  3. Materials and methods • 276 patients with adenocarcinoma of the prostate • Randomised to 4 or 8 months of NAD before RT. • EF data were recorded at baseline and at each follow-up visit • Physician directed questions, using a 4-point grading system.

  4. Results 230 patients were included in the analysis of EF and were followed for a median of 80 months. 141 patients had EF at baseline. Neo-adjuvant androgen deprivation in addition to radiation therapy caused a significant reduction in EF. The most significant reduction in EF happens within the first year. The median time to grade 3–4 EF toxicity was 14.6 months. The cumulative probability of EF preservation at 5 years was 28% (22–34) in arm 1 and 24% (19–30) in arm 2. Age was a significant predictor of post-treatment EF.

  5. Conclusion • This randomised trial provides us with unique long term follow up data. • When counselling men about EF prior to a course of neoadjuvant androgen deprivation therapy in combination with external beam radiotherapy for localised prostate cancer we must emphasise that the first year post treatment poses the greatest risk to sexual function and a continued decline may be expected. • Age is also a consideration with younger men having a greater chance of retaining erectile function. • However, 26% of men can expect to retain sexual function at 5 years.

  6. References [1] Turner SL, Adams K, Bull CA, Berry MP. Sexual dysfunction after radical radiation therapy for prostate cancer: a prospective evaluation. Urology 1999;54:124–9. [2] Incrocci L, Slob AK, Levendag PC. Sexual (dys)function after radiotherapy for prostate cancer: a review. Int J RadiatOncolBiolPhys 2002; 52:681–93. [3] Robinson JW, Mortiz S, Fung T. Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma. Int J RadiatOncolBiolPhys 2002;54:1063–8. [4] Potosky AL, Reeve BB, Clegg LX, et al. Quality of life following localized prostate cancer treated initially with androgen deprivation therapy or no therapy. J Natl Cancer Inst 2002;94:430–7. [5] Shelley MD, Kumar S, Wilt T, et al. A systematic review and meta-analysis of randomised trials of neo-adjuvant hormone therapy for localised and locally advanced prostate carcinoma. Cancer Treat Rev 2009;35:9–17

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