Association between erectile function and lower urinary tract symptoms in patients treated with permanent seed prostate brachytherapy
Taussky Daniel; Delouya Guila; Lefebvre Fabio; Liu Aihua; Abrahamowicz Michal; Bahary Jean-Paul; Donath David;
Department of Radiation Oncology, University of Montreal Medical Centre (CHUM), Montreal, Quebec, Canada
PURPOSE: Among men who underwent permanent seed prostate brachytherapy, we aimed to: 1) investigate: whether development of lower urinary tract symptoms (LUTS) after permanent seed prostate brachytherapy was associated with suboptimal erectile function before brachytherapy, and 2) identify factors that are associated with normal erectile function before brachytherapy. METHODS AND MATERIALS: We analyzed data from 215 consecutive patients with low- or intermediate-risk prostate cancer who received permanent seed brachytherapy at our center. Erectile function at baseline (prior to brachytherapy) was assessed using the Mount Sinai Erectile Function Score (MSEFS). Urinary symptoms at baseline and at 1 month and 4 months after brachytherapy were measured using the International Prostate Symptom Score (IPSS) questionnaire. Multiple linear regression, and a multivariable mixed linear model were used to analyze differences in IPSS from baseline to 1 month and 4 months after brachytherapy. Multiple logistic regression was used to investigate factors associated with normal erectile function at baseline. RESULTS: A total of 124 patients had data available for baseline, and 1 month and 4 months after brachytherapy. Having normal erectile function (MSEFS of 3) versus suboptimal erectile function (MSEFS 0 to 2) was not associated with increases in IPSS from baseline to 1 month or 4 months after brachytherapy. Larger increases in IPSS were found in subjects who had smaller prostates (regression coefficient = -0.36) or higher seed radioactivity (regression coefficient = 0.33). Patients with higher baseline IPSS were less likely to have normal erectile function (MSEFS = 3) before brachytherapy (odds ratio = 0.88). CONCLUSION: Normal erectile function prior to brachytherapy was not associated with worse IPSS after brachytherapy. However, patients with a higher IPSS before brachytherapy also had worse erectile function before brachytherapy, which may point to a common pathway.