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Original Contribution
September 21, 2011

Prediction of Erectile Function Following Treatment for Prostate Cancer

Author Affiliations

Author Affiliations: Urology Division (Drs Alemozaffar and Sanda) and Radiation Oncology Department (Dr Kaplan), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard Medical School (Dr Regan); Department of Urology, University of California, San Francisco (Drs Cooperberg, Sadetsky, and Carroll); Departments of Urology (Drs Wei and Wood) and Radiation Oncology (Dr Hamstra) and Biostatistics Core (Mr Dunn), School of Medicine, University of Michigan, Ann Arbor; Departments of Radiation Oncology (Dr Michalski) and Surgery (Dr Kibel), Washington University, St Louis, Missouri; Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California (Dr Sandler); Office for Survey Research, Institute for Public Policy and Social Research, Michigan State University, East Lansing (Dr Hembroff); Departments of Urology (Drs Saigal and Litwin) and Health Services (Dr Litwin), UCLA Center for Health Sciences, Los Angeles; Glickman Urological and Kidney Institute (Dr Klein) and Department of Radiation Oncology (Dr Ciezki), Cleveland Clinic Hospitals, Cleveland, Ohio; and Departments of Urology (Dr Pisters) and Radiation Oncology (Dr Kuban), M.D. Anderson Cancer Center, Houston, Texas.

JAMA. 2011;306(11):1205-1214. doi:10.1001/jama.2011.1333

Context Sexual function is the health-related quality of life (HRQOL) domain most commonly impaired after prostate cancer treatment; however, validated tools to enable personalized prediction of erectile dysfunction after prostate cancer treatment are lacking.

Objective To predict long-term erectile function following prostate cancer treatment based on individual patient and treatment characteristics.

Design Pretreatment patient characteristics, sexual HRQOL, and treatment details measured in a longitudinal academic multicenter cohort (Prostate Cancer Outcomes and Satisfaction With Treatment Quality Assessment; enrolled from 2003 through 2006), were used to develop models predicting erectile function 2 years after treatment. A community-based cohort (community-based Cancer of the Prostate Strategic Urologic Research Endeavor [CaPSURE]; enrolled 1995 through 2007) externally validated model performance. Patients in US academic and community-based practices whose HRQOL was measured pretreatment (N = 1201) underwent follow-up after prostatectomy, external radiotherapy, or brachytherapy for prostate cancer. Sexual outcomes among men completing 2 years' follow-up (n = 1027) were used to develop models predicting erectile function that were externally validated among 1913 patients in a community-based cohort.

Main Outcome Measures Patient-reported functional erections suitable for intercourse 2 years following prostate cancer treatment.

Results Two years after prostate cancer treatment, 368 (37% [95% CI, 34%-40%]) of all patients and 335 (48% [95% CI, 45%-52%]) of those with functional erections prior to treatment reported functional erections; 531 (53% [95% CI, 50%-56%]) of patients without penile prostheses reported use of medications or other devices for erectile dysfunction. Pretreatment sexual HRQOL score, age, serum prostate-specific antigen level, race/ethnicity, body mass index, and intended treatment details were associated with functional erections 2 years after treatment. Multivariable logistic regression models predicting erectile function estimated 2-year function probabilities from as low as 10% or less to as high as 70% or greater depending on the individual's pretreatment patient characteristics and treatment details. The models performed well in predicting erections in external validation among CaPSURE cohort patients (areas under the receiver operating characteristic curve, 0.77 [95% CI, 0.74-0.80] for prostatectomy; 0.87 [95% CI, 0.80-0.94] for external radiotherapy; and 0.90 [95% CI, 0.85-0.95] for brachytherapy).

Conclusion Stratification by pretreatment patient characteristics and treatment details enables prediction of erectile function 2 years after prostatectomy, external radiotherapy, or brachytherapy for prostate cancer.