Predicting Sexual Ability After Prostate Cancer Treatment

Sept. 20, 2011 -- The better a man's erections before prostate cancer treatment, the more likely he is to recover the ability to have erections later.

Martin G. Sanda, MD, and colleagues followed 1,027 men for two years after prostate cancer treatment. The researchers focused on the men's ability to have erections. They evaluated which factors helped to predict that.

''The key factor influencing how men did long term is how men did before treatment," Sanda says. He is director of the Prostate Care Center at Beth Israel Deaconess Medical Center and associate professor of surgery at Harvard Medical School.

"That may seem like a no-brainer," he tells WebMD.

However, he says his new study is one of the first to help predict, scientifically, what men can expect in terms of sexual recovery after prostate cancer treatment.

By evaluating different treatments and characteristics, Sanda has developed a prediction model. It can be used by doctors and patients to help predict sexual recovery.

Besides pretreatment erections, he found that age, treatment type, and other factors affect sexual recovery.

About 240,000 men will get a prostate cancer diagnosis this year, according to the American Cancer Society. About 34,000 men will die this year from prostate cancer.

The study was funded by the National Institutes of Health. It is published in the Journal of the American Medical Association.

Evaluating Sexual Function

The researchers evaluated men with prostate cancer who sought care from 2003 to 2006 at nine hospitals in the U.S.

The men were enrolled in the Prostate Cancer Outcomes and Satisfaction With Treatment Quality Assessment (PROSTQA).

In all, 1,027 completed the 24-month study. The men responded to telephone interviews and questionnaires at four different times during the two years.

The main outcome the researchers looked at were erections adequate for intercourse. The men answered such questions as: "How would you describe the usual quality of your erection during the last four weeks?"

Most of these men (524) had their prostate removed, called a prostatectomy. Another 241 had external beam radiation, and 262 had implantation of radioactive ''seeds" or brachytherapy.

Sexual Ability After Treatment

Two years after treatment, the researchers found that 37% of the men, overall, reported good erections. The men's ability to sustain an erection adequate for intercourse varied by the type of treatment. Overall, considering both the men who could and could not get a good erection before treatment, the researchers found:

• 35% of men who had prostate removal reported good erections two years later.
• 37% of men who had external radiation did.
• 43% of men who had radioactive seeds did.

When the researchers focused only on the men who reported having functional erections before treatment, they found that 48% of those men overall recovered that ability two years later.