The Impact Of Treatment Choice For Localized Prostate Cancer On Response To Phosphodiesterase Inhibitors

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Clinical Trials / Drug Trials
Article Date: 19 Apr 2008 - 0:00 PDT

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UroToday.com - In the March, 2008 issue of the Journal of Urology, Dr. Lee and colleagues report an analysis that the choice of radical prostatectomy (RP) or radiotherapy (RT) for localized prostate cancer (CaP) is unlikely to have an impact of response to phosphodiesterase type 5 inhibitors (PDEIs) after treatment.

The study sought to assess erectile function after RP or RT as HRQOL is an increasingly important outcome to patients and physicians. The longitudinal database CaPSURE was used to assess 1,087 patients treated with RP (846) or RT (241) and who initiated PDEIs after treatment. Participants completed the UCLA Prostate Cancer Index, a validated disease specific HRQOL instrument that measures sexual function (SF) and sexual bother (SB). A response to PDEIs was defined as an increase from baseline score of at least half the standard deviation in the study population. The threshold was 12 points for SF and 16 points for SB.

PDEIs were used by 63% of RP and 31% of RT patients. At least 3 questionnaires were completed by participants and the median was 8. Among RP men, 60% had undergone a bilateral nerve sparing procedure. Among RT patients, 62% had brachytherapy and 21% had external beam radiation. Hormonal deprivation therapy was given to 15% of RT patients as neoadjuvant and 15% had neoadjuvant and adjuvant, but 50% of RT men received no hormone deprivation therapy. RT patients were less healthy, older and with lower SF baseline scores. RP patients initiated PDEIs on average at 11 months, compared to 17 months for RT patients.

RP patients had lower SF/SB scores before PDEIs, but there were similar increases in SF scores when comparing adjusted scores from pre-PDEI assessments to scores on the initial assessment after starting PDEIs. SF and SB scores continually increased for RP patients while the cores of RT patients showed little change. The mean increase in SF scores was 6.4 and 5.1 for RP and RT patients, respectively. The mean change in SB after initiating treatment was 3.8 for RP and 8.0 for RT, which were not significant. The overall response rates were 30% for SF and 32% for SB regardless of the prostate cancer treatment given. No differences were found for nerve-sparing vs. non-nerve-sparing, use of hormonal deprivation therapy, or external beam RT vs. brachytherapy. The only significant predictors of response on multivariate response were SF scores at baseline and at PDEI initiation. The authors suggest that those men with higher pre-PDEI scores may lie on a less dynamic part of the SF scale and have a more difficulty meeting the threshold for response.

Lee IH, Sadetsky N, Carroll PR, Sandler HM

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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