PSA biochemical control and risk of erectile dysfunction for young men undergoing prostate brachytherapy

Purpose: The purpose of this study is to evaluate the likelihood of maintaining erectile function and PSA biochemical freedom from relapse for young men opting for definitive treatment of prostate cancer incorporating permanent prostate brachytherapy. Materials and Methods: Between 3/1/95 and 6/1/00, a total of 497 patients with a median age of 69 years (range 41 to 82) underwent permanent prostate brachytherapy. A total of 175 of these patients were age 65 or less. Within this group, 97 patients were between 60 and 65 years old, and 78 were younger than 60 years. There were 99 Caucasian and 76 African-American patients. At presentation, 68% (119/175) reported normal or sufficient erectile function for intercourse. Implant alone, implant plus androgen suppression, external radiotherapy plus implant and external radiotherapy plus implant and androgen suppression were performed in 70, 26, 31, and 48 patients, respectively. In those receiving androgen suppression the median duration of therapy was 6 months (range 1-14 months). Factors associated with the development of erectile dysfunction after treatment were evaluated, including age, race, use and duration of androgen suppression, addition of external radiotherapy. Results: With a median followup of 28 months, the overall likelihood of retaining erectile function was 59% and freedom from biochemical PSA relapse was 91% for these young men. The likelihood of retaining erectile function for the implant alone, implant plus androgen suppression, external radiotherapy plus implant and external radiotherapy plus implant and androgen suppression groups were 79%, 53%, 68% and 53%, respectively. Race, age, and the addition of external radiotherapy did not significantly impact on the development of erectile dysfunction. The use of androgen suppression was associated with a significant increase in erectile dysfunction (p= .02). Conclusion: This study reports that the use of prostate brachytherapy is associated with a low rate of erectile dysfunction when delivered as monotherapy, or in combination with external radiotherapy. PSA biochemical freedom from progression is excellent in this group of young men. The addition of androgen suppression is associated with an increased risk of long-term erectile dysfunction.