Potency after permanent prostate brachytherapy for localized prostate cancer

Purpose: The evaluation of potency preservation after treatment of localize d prostate cancer with transperineal permanent prostate brachytherapy (PPS) and the efficacy of sildenafil were studied. Methods and Materials: This study comprised 482 patients who were able to m aintain an erection suitable for intercourse a ore treatment from a cohort of 1166 patients with clinically localized prostate cancer treated with PPB . All patients have been followed prospectively, and actuarial analysis was performed to assess potency preservation over time. Patients treated with sildenafil were evaluated as to its efficacy. Results: The median follow-up of this cohort was 34 months (6-92), with a m edian age of 68 years (47-80). Potency was preserved in 311 of the 482 pati ents, with a 5-year actuarial potency rate of 52.7%. The 5-year actuarial p otency rate for patients treated with PPB as monotherapy was 76%, and, for those treated with combination external beam radiotherapy (EBT) + PPB, 56% (p = 0.08). Patients treated with neoadjuvant androgen deprivation (NAAD) PPB had a 5-year potency rate of 52%, whereas those with combination EBT PPB + NAAD had a potency rate of 29% (p = 0.13). Cox regression analysis i dentified that pretreatment use of NAAD and patient age predicted for impot ence (p = 0.0001 and 0.04, respectively). OF 84 patients treated with silde nafil, 52 had a successful outcome (62%). The response to sildenafil was si gnificantly better in those patients not treated with NAAD (p = 0.04). Conclusions: The actuarial potency rates at 5 years for patients treated wi th PPB are lower than generally ac snow aged, except for those patients tre ated with PPB as monotherapy. Patients who received sildenafil exhibited im proved potency in a majority of cases. (C) 2001 Elsevier Science Inc.