ERECTILE DYSFUNCTION FOLLOWING MINIMALLY INVASIVE TREATMENTS FOR PROSTATE-CANCER

Objectives. Cryosurgical ablation of the prostate (CSAP) and interstit ial radiotherapy (IR) are relatively new procedures intended to be les s invasive than radical prostatectomy for the treatment of prostate ca ncer. Despite absence of long-term or intermediate data on efficacy, m any patients choose one of these therapies because they presume their potency will be maintained. We report our experience with CSAP, IR, an d postprocedure erectile dysfunction. Methods, Global sexual assessmen ts were made at 12 months after therapy in 28 CSAP patients, and at 18 months in 37 IR patients. Each patient was contacted by telephone fol lowing his procedure. The patients were asked several questions regard ing their sexual function both preoperatively and postoperatively. The questionnaire was administered only to the patient. Results. Twenty-e ight of 36 patients who underwent CSAP responded to the questionnaire (78%). Twenty patients were potent preoperatively (71%). The mean age of the potent group was 69 years (range 54 to 82). Following therapy, 2 of these patients (10%) reported potency at 12 months. Thirty-seven of 42 patients who underwent IR responded to the questionnaire (88%). Twenty-seven were potent preoperatively (73%). The mean age of the pot ent group was 70 years (range 56 to 83). The mean follow-up was 18 mon ths (range 5 to 36). following therapy, 15 patients reported potency ( 55%). All of the patients who reported potency felt that the quality o f their erections had decreased following radiation. Conclusions. Our short-term results with IR and CSAP suggest a significant adverse effe ct on erectile function. Our results suggest that enhanced preservatio n of potency should not be used as an enticement in the promotion of I R or CSAP.