NewYork Presbyterian/Weill Cornell Medical College
Introduction: Men with prostate cancer initially treated with radical prostatectomy (RP) who later undergo radiation (RT) and androgen deprivation therapy (ADT) in the adjuvant or salvage setting are at high risk for erectile dysfunction; however, this risk is not well quantified. We aimed to identify predictors of erectile function (EF) preservation this cohort treated with “triple therapy” (TTX). Methods: We included men who underwent RP and subsequent adjuvant or salvage RT+ADT aka TTX but excluded men treated with ADT pre-RP. We extracted data on pre-RP ED-related comorbidities, total testosterone (T) levels, cancer and treatment characteristics, and sexual function. We analyzed International Index of Erectile Dysfunction (IIEF) Erectile Function Domain (EFD) score and phosphodiesterase 5 inhibitor (PDE5i) use documented pre-RP, 12 months (m) post-RP, and 12 m and 24 m post-TTX. PDE5i use was scored on a Likert scale of 0-3 (0: never; 3: routinely). NSS of each side (R/L) was scored on a 1-4 scale: 1 complete vs 2 near complete preservation (both considered nerve-sparing) and 3 partial vs 4 complete resection (both considered non-nerve-sparing). We then classified overall NS status as bilateral, unilateral, or not-spared. Multivariable analysis (MVA) was performed to define factors associated with EFD scores =10 (severe ED) and = 24 (functional erections) at 24 m after TTX completion. Results: We analyzed 163 men with a mean age of 63 years. 47% had =2 comorbidities. Median (IQR) total T 361 (26, 456) ng/dL. 18% had pre-RP T < 300. 50% had bilateral NS. Median time between RP and start of RT was 18 (9, 34) m. Median duration of ADT: 4 (3, 6) m; 66% received >3 m ADT. Median EFD pre-RP = 26 (17, 30) vs 6 (2, 20) at 24 m post-TTX. Mean difference in EFD pre-RP vs 24m post-TTX was 11 (95% CI 9-12, p<0.0001). 18% had EFD =10 pre-RP vs 62% at 24 m post-TTX. 60% had EFD = 24 pre-RP vs 15% at 24 m post-TTX. On MVA (table), pre-RP EFD and bilateral NS were found to be significantly (p < 0.05) associated with both EFD =10 and EFD = 24. Age, =2 comorbidities, time between RP and RT, duration of ADT, and routine PDE5i use were not significant predictors in either model. Conclusions: This analysis identified pre-RP EF and surgeon-reported NS score as the only significant predictors of severe ED and functional recovery of erections 24 m after completion of TTX. SOURCE OF Funding: None
