Prediction models help determine likelihood of erectile function after treatment for prostate cancer

September 20, 2011

CHICAGO - The development of prediction models that included variables such as pretreatment sexual function, patient characteristics and treatment factors appear to be effective at predicting erectile function 2 years after prostatectomy, external radiotherapy, or brachytherapy for prostate cancer, according to a study in the September 21 issue of JAMA.

"Because most patients survive early-stage prostate cancer after treatment, health-related quality of life (HRQOL) outcomes have emerged as a major emphasis in treatment decisions. Erectile dysfunction is commonplace after prostate cancer treatment and has significant consequences for HRQOL. Among urinary, bowel, vitality, and sexual HRQOL domains--outcomes commonly impaired by prostate cancer treatment--sexual function in previously potent men is the most commonly impaired and is closely related to outcome satisfaction," the authors write. Information regarding how the combination of pretreatment patient characteristics and treatment factors relate to individualized sexual outcome remains limited.

Mehrdad Alemozaffar, M.D., of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and colleagues conducted a study to determine whether an individual man's sexual outcomes after the most common treatments for early-stage prostate cancer can be predicted accurately based on baseline characteristics and treatment plans. Information from an academic multicenter cohort (enrolled from 2003 through 2006), including pretreatment patient characteristics, sexual HRQOL, and treatment details, was used to develop models predicting erectile function 2 years after treatment. A community-based cohort (CaPSURE; enrolled 1995 through 2007) externally validated the performance of the model. Patients in U.S. academic and community-based practices whose HRQOL was measured pretreatment (n = 1,201) underwent follow-up after prostatectomy, external radiotherapy, or brachytherapy for prostate cancer. Sexual outcomes among men completing 2 years of follow-up (n = 1,027) were used to develop models predicting erectile function that were externally validated among 1,913 patients in a community-based cohort.

The researchers found that 2 years after treatment, 177 of 511 (35 percent) men who underwent prostatectomy reported the ability to attain functional erections suitable for intercourse; this corresponding figure was 37 percent (84 of 229) of men who had received external radiotherapy as their primary therapy; and 43 percent (107 of 247) of men who had received brachytherapy as primary treatment.

"Pretreatment sexual HRQOL score, age, serum prostate-specific antigen level, race/ethnicity, body mass index, and intended treatment details were associated with functional erections 2 years after treatment. Multivariable logistic regression models predicting erectile function estimated 2-year function probabilities from as low as 10 percent or less to as high as 70 percent or greater depending on the individual's pretreatment patient characteristics and treatment details. The models performed well in predicting erections in external validation among CaPSURE cohort patients," the authors write.

"We have developed clinically applicable models to predict recovery of erectile function following prostatectomy, external radiotherapy, or brachytherapy for early-stage prostate cancer based on pretreatment sexual function, patient characteristics, and specific plan of treatment. External validation of this predictive model in a community-based cohort suggests that these findings are generalizable and may help physicians and patients to set personalized expectations regarding prospects for erectile function in the years following primary treatment for prostate cancer," the researchers conclude.

(JAMA. 2011;306[11]:1205-1214. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Please Note: For this study, there will be multimedia content available, including the JAMA Report video, embedded and downloadable video, audio files, text, documents, and related links. This content will be available at 3 p.m. CT Tuesday, September 20 at this link.

Editorial: Helping Patients Make Better Personal Health Decisions

In an accompanying editorial, Michael J. Barry, M.D., of Massachusetts General Hospital, Boston, writes that routinely collecting objective measures of subjective phenomena from patients will need to become part of usual care rather than just research to optimize outcome prediction.

"More importantly, better ways of ensuring that patients are informed about their choices and invited to participate in making decisions need to be identified and disseminated. Outcomes data for all important options and outcomes need to be integrated in a useful synthesis for the broad spectrum of men facing this decision. A meta-analysis of randomized trials of patient decision aids to support a shared decision-making process for preference-sensitive conditions demonstrated better decision quality when these tools are used. For the most fateful decisions, coaches or navigators may be helpful and efficient as well."

"The promise of patient-centered outcomes research will be realized not only when high-quality outcomes data are available for all common medical problems but also when patients are routinely informed and invited to participate in their health care decisions. To achieve this promise, patients must increasingly be encouraged to adopt the position of 'no decision about me, without me.'"

(JAMA. 2011;306[10]:1258-1259. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
-end-
To contact corresponding author Martin G. Sanda, M.D., call Jerry Berger at 617-667-7308 or email jberger@bidmc.harvard.edu. To contact editorial author Michael J. Barry, M.D., call Sue McGreevey at 617-724-2764 or email smcgreevey@partners.org.

The JAMA Network Journals

Related Prostate Cancer Articles from Brightsurf:

Low risk of cancer spread on active surveillance for early prostate cancer
Men undergoing active surveillance for prostate cancer have very low rates - one percent or less - of cancer spread (metastases) or death from prostate cancer, according to a recent study published in the Journal of Urology®, an Official Journal of the American Urological Association (AUA).

ESMO 2020: Breast cancer drug set to transform prostate cancer treatment
A drug used to treat breast and ovarian cancer can extend the lives of some men with prostate cancer and should become a new standard treatment for the disease, concludes a major trial which is set to change clinical practice.

Major trial shows breast cancer drug can hit prostate cancer Achilles heel
A drug already licensed for the treatment of breast and ovarian cancers is more effective than targeted hormone therapy at keeping cancer in check in some men with advanced prostate cancer, a major clinical trial reports.

The Lancet: Prostate cancer study finds molecular imaging could transform management of patients with aggressive cancer
Results from a randomised controlled trial involving 300 prostate cancer patients find that a molecular imaging technique is more accurate than conventional medical imaging and recommends the scans be introduced into routine clinical practice.

Common genetic defect in prostate cancer inspires path to new anti-cancer drugs
Researchers found that, in prostate cancer, a mutation leading to the loss of one allele of a tumor suppressor gene known as PPP2R2A is enough to worsen a tumor caused by other mutations.

First prostate cancer therapy to target genes delays cancer progression
For the first time, prostate cancer has been treated based on the genetic makeup of the cancer, resulting in delayed disease progression, delayed time to pain progression, and potentially extending lives in patients with advanced, metastatic prostate cancer, reports a large phase 3 trial.

Men taking medications for enlarged prostate face delays in prostate cancer diagnosis
University of California San Diego School of Medicine researchers report that men treated with medications for benign prostatic hyperplasia (enlarged prostate) experienced a two-year delay in diagnosis of their prostate cancer and were twice as likely to have advanced disease upon diagnosis.

CNIO researchers confirm links between aggressive prostate cancer and hereditary breast cancer
The study has potential implications for families with members suffering from these types of tumours who are at an increased risk of developing cancer.

Distinguishing fatal prostate cancer from 'manageable' cancer now possible
Scientists at the University of York have found a way of distinguishing between fatal prostate cancer and manageable cancer, which could reduce unnecessary surgeries and radiotherapy.

Researchers find prostate cancer drug byproduct can fuel cancer cells
A genetic anomaly in certain men with prostate cancer may impact their response to common drugs used to treat the disease, according to new research at Cleveland Clinic.

Read More: Prostate Cancer News and Prostate Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.