CHICAGO, IL USA (UroToday) - During the World Meeting on Sexual Medicine, Luca Incrocci, MD, PhD presented his perspective on the impact of radiation therapy on the prostate cancer (PCa). Sexual function significantly decreases after radiotherapy for prostate cancer; however, a multidisciplinary approach to treatment is necessary for improved results.
“The patient’s vascular physiology (in particular the pudendal artery) is important in relationship to external beam radiation for prostate cancer. Even with improvements in radiation technology, there is still a high incidence of sexual dysfunction in these patients,” said Dr. Incrocci. The incidence of erectile dysfunction (ED) after external-beam radiotherapy and brachytherapy is significant (7-89% [mean 40%]), yet patients will wait one to three years before complaining about ED. This data is based on prospective, well-performed clinical trials.
The ED post-radiation therapy is related to arterial injury, arterial occlusion, and cavernosal arterial insufficiency as well as endothelial dysfunction and structural alterations in the corporal smooth muscle. The greatest risk is to the vascular integrity of the distal pudendal arteries and crurae. Other vascular risk factors include DM, hypercholesterolemia, and smoking. “The ED resulting from post-prostatectomy is a vicious cycle.”
Click here to view Dr. Incrocci's slide presentation from this session
Dr. Incrocci presented results from two studies: One of sildenafil and ED after EBRT for PCa (Incrocci, et al., IJROBP 2001) citing > 55% of the patients achieved successful intercourse attempts and responded well to sildenafil. A second 2006 study assessed the efficacy of tadalafil in PCa patients after 3D-conformal external-beam radiotherapy demonstrating 48% of these patients responded well to this medication and indicating the treatment lead to successful intercourse.
The most common sexual complaints are loss of ejaculation, pain at orgasm, and diminished libido. Psychological considerations such as anxiety, depression, anger, financial difficulties, and occupational changes may contribute to disruption of sexual activity. These stresses should be talked about between the patient and his partner and with the radiation oncologist and physicians involved in managing follow-up care.
Presented by Luca Incrocci, MD, PhD* at the annual World Meeting on Sexual Medicine (WMSM) - August 26 - 30, 2012 - Sheraton Chicago - Chicago, Illinois USA
*Associate Professor of Radiation Oncology
Erasmus MC-Daniel den Hoed Cancer Center
Rotterdam, The Netherlands
Reported for UroToday by Karen Roberts, Medical Editor
