ERECTILE FUNCTIONING OF MEN TREATED FOR PROSTATE CARCINOMA

BACKGROUND. Published reports of complication rates, such as erectile dysfunction, associated with treatments for prostate carcinoma are oft en used to guide patient decision-making and develop clinical guidelin es, Unfortunately, the published data are largely comprised of case se ries from single institutions, Metaanalysis is a methodology for combi ning findings from several studies to produce a better result. METHODS , A comprehensive literature review and subsequent meta-analysis of th e rates of erectile dysfunction associated with external beam radiothe rapy and radical prostatectomy was conducted. A simple logistic regres sion model was used to combine the data from 40 articles that mel sele ction criteria. RESULTS, The probability of maintaining erectile funct ioning after radiotherapy is 0.69. The probability after surgery is 0. 42. This difference is significant. Analysis of the effects of variabl es such as patient age and stage of disease on erectile functioning co uld not be performed due to inconsistencies across Studies and the lim ited number of studies reporting such variables. CONCLUSIONS. The publ ished data indicate that men with normal erectile functioning are more likely to retain this function after radiotherapy than after surgery. Attention is drawn to the weaknesses in the reviewed studies in the h ope thar the clinical trials of emerging treatments, such as cryothera py, brachytherapy, three-dimensional conformal radiotherapy, and neoad juvant hormones can be strengthened to reflect more accurately the rat e of treatment-associated erectile dysfunction. (C) 1997 American Canc er Society.