POTENCY FOLLOWING HIGH-DOSE 3-DIMENSIONAL CONFORMAL RADIOTHERAPY AND THE IMPACT OF PRIOR MAJOR UROLOGIC SURGICAL-PROCEDURES IN PATIENTS TREATED FOR PROSTATE-CANCER

Purpose: To assess the impact of high-dose three-dimensional conformal radiotherapy (3DCRT) on potency in patients treated for clinically lo calized prostate cancer and to identify factors that might predict the outcome of sexual function following treatment. Methods and Materials : One hundred twenty-four consecutive patients treated with 3DCRT for localized prostate cancer at UCSF between 1991-1993 were included in t his retrospective analysis. Patient responses were obtained from a mai led questionnaire, telephone interviews, or departmental records. Medi an follow-up was 21 months. Results: Sixty patients reported having se xual function prior to 3DCRT, including 47 who were fully patent and 1 3 who were marginally potent. Of the remaining 64 patients, 45 were im potent, 7 were on hormones, 1 was status-postorchiectomy, and 11 were not evaluable. Following 3DCRT, 37 of 60 patients (62%) retained sexua l function sufficient for intercourse. Of those with sexual function b efore irradiation, 33 of 47 (70%) of patients fully potent and 4 of 13 (31%) of patients marginally potent maintained function sufficient fo r intercourse (p < 0.01). Potency was retained in 6 of 15 (40%) patien ts with a history of a major urologic surgical procedure (MUSP) and in 31 of 45 (69%) with no history of a MUSP (p < 0.04). Transurethral re section of the prostate was the MUSP in eight of these patients, with four (50%) maintaining sexual function. Conclusions: Patients who rece ive definitive 3DCRT for localized prostate cancer appear to maintain potency similar to patients treated with conventional radiotherapy. Ho wever, patients who are marginally potent at presentation or who have a history of a MUSP appear to be at increased risk of impotence follow ing 3DCRT.