SAN DIEGO—The timing of adjuvant or salvage radiotherapy (RT) can affect erectile function recovery following radical prostatectomy (RP), according to new research presented at the 2016 American Urological Association annual meeting.
A team led by Giorgio Gandaglia, MD, and Alberto Briganti, MD, of IRCCS Ospedale San Raffaele in Milan, Italy, identified 364 patients with localized prostate cancer treated with RP at a single center during 1995–2015. The men subsequently received RT: 116 patients (31.9%) received adjuvant RT and 248 (68.1%) salvage RT following a rise in PSA level.
The median time from surgery to RT was 4 months. The median preoperative erectile function score was 24 by the International Index of Erectile Function-Erectile Function domain (IIEF-EF). An IIEF-EF score of 22 and greater indicated erectile function recovery.
Men who received postoperative RT generally had poor erectile function recovery. The 3-year recovery rate after RT was just 18%. In multivariable analysis, 3-year recovery rates were higher among patients receiving salvage versus adjuvant RT (31.2% vs. 11.8%, respectively).
Time lapse between surgery and RT predicted recovery. The most informative cut-off for time from surgery to RT was 16 months, according to Kaplan-Meier analyses. The 3-year recovery rates were higher for patients receiving RT after 16 months compared with before (34.9% vs. 12.6%). The investigators adjusted for patient age, body mass index, comorbidities, preoperative IIEF-EF, and nerve-sparing status.
When RT is postponed, it may allow more time for better healing of surgical damage. “Our study demonstrates that delaying radiotherapy when oncologically safe might have a positive impact on postoperative quality of life,” Dr Gandaglia told Renal & Urology News. “Therefore, the oncologic benefits and possible side effects of additional cancer therapies after radical prostatectomy should be carefully balanced in men with prostate cancer. When oncologically safe, postoperative radiotherapy should be delayed until the first sign of recurrence in order to improve erectile function recovery rates and, in turn, quality of life after surgery.”