Side Effects: Erec-le Dysfunc-on. Armin Thöni, Hans Neuenschwander, Jörn Wulf Lindenhofspital, Bern, Switzerland. Side Effects: Erec-le Dysfunc-on
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1 Armin Thöni, Hans Neuenschwander, Jörn Wulf Lindenhofspital,
2 Prostate Seed Implanta0on (PSI) at Lindenhofspital Bern since pa0ents at total 2004 n = n = n = n = n = n = n = n = consecu0ve pa0ents for evalua0on
3 Un0l end of 2011: Follow up of the 400 pts. Visite # pts. prior to PSI weeks aner months year years years median f/u 2.8 years (35 month)
4 Interna-onal Index of Erec-le Func-on IIEF- score Pa0ent ques0onnaire 5 ques0ons: IIEF- 5
5 5 ques0ons: when you atempted intercourse Confidence to get and to keep an erec0on Erec0on hard enough to penetrate Ability to maintain erec0on during intercourse Ability to maintain erec0on to comple0on of intercourse Was intercourse sa0sfactory 0 5 points (the more the beter) did not atempt (almost) never <50% 50% >50% always IIEF- 5
6 IIEF- 5- score based evalua0on (1 25 points) acc. to: Rhoden et al: Int J of Impotence Research, 2002: 5 categories of erec0le dysfunc0on no points mild points mild moderate points moderate 8 11 points severe < 8 points
7 Prostate Brachytherapy Side effects: Evalua0on of Erec0le Dysfunc0on RESULTS
8 Comparison with the ProBrachy Database Lindenhofspital ProBrachy Database N IIE- 5 MiJelwert N IIE- 5 MiJelwert Baseline weeks months year years years Baseline months months year years years by Courtesy of St. Machtens
9 Dependence of IIEF- score on pre- therapeu0c condi0on median values: IIEF Sum: Dependence on ini-al IIEF (median values) Visite 0 (N=400) Visite 1 Visite 2 Visite 3 Visite 4 Visite 5 (N=390) (N=370) (N=334) (N=264) (N=171) 6 weeks 6 months 1 year 2 years 3 years no IIEF (N=134-59) mild IIEF (N=124-55) mild- moderate IIEF (N=72-32) moderate IIEF 8-11 (N=19-7) severe IIEF <8 (N=51-18)
10 Dependence of IIEF- score on pre- therapeu0c condi0on: median and confidence intervals in the favourable group IIEF Sum: Dependence on ini-al IIEF (median values) Visite 0 (N=400) Visite 1 Visite 2 Visite 3 Visite 4 Visite 5 (N=390) (N=370) (N=334) (N=264) (N=171) 6 weeks 6 months 1 year 2 years 3 years no IIEF (N=134-59) mild IIEF (N=124-55) mild- moderate IIEF (N=72-32) moderate IIEF 8-11 (N=19-7) severe IIEF <8 (N=51-18)
11 Pa0ents with ini0ally normal potency (IIEF >21) S0ll have normal potency: ini-ally 6 weeks 6 Months 1 year 2 years 3years IIEF >21 134/134 37/132 58/122 45/109 45/91 31/59 = no ED 100% 28% 48% 41% 50% 53% S0ll have normal potency or only mild ED: ini-ally 6 weeks 6 Months 1 year 2 years 3years IIEF >16 134/134 77/132 91/122 81/109 69/91 43/59 = no or mild ED 100% 58% 75% 74% 76% 73%
12 Pa0ents with ini0ally mild ED (IIEF >16 and <21) S0ll have no or mild ED: ini-ally 6 weeks 6 Months 1 year 2 years 3years IIEF >16 (<21) 124/124 33/118 40/114 49/105 34/84 21/55 = no or mild ED 100% 28% 35% 47% 41% 38% S0ll have beter than moderate ED: ini-ally 6 weeks 6 Months 1 year 2 years 3years IIEF /124 60/118 70/114 78/105 61/84 33/55 > moderate ED 100% 51% 61% 74% 72% 60%
13 Pa0ents with ini0ally no or mild ED (IIEF >16) S0ll have normal potency or mild ED: Group 1 and Group 2 ini-ally 6 weeks 6 Months 1 year 2 years 3years IIEF >16 258/ / / / /175 64/114 = no or mild ED 100% 44% 56% 61% 59% 56%
14 Influence on Quality of Life? No 100.0% 90.0% 80.0% no mild mild-moderate moderate 8-11 severe <8 70.0% 60.0% Visite 0 Visite 1 Visite 2 Visite 3 Visite 4 Visite 5
15 Comparison between younger than 60 and older than 60 IS AGE IMPORTANT?
16 No ED: < 60y vs 60y IIEF Sum: ini-al >21 (median values) IIEF 22-25, <60y (N=57-26) IIEF 22-25, 60y (N=77-33) Visite 0 Visite 1 Visite 2 Visite 3 Visite 4 Visite 5
17 Pa0ents with ini0ally normal potency younger than 60 years and s0ll no ED ini-ally 6 weeks 6 Months 1 year 2 years 3years IIEF > 21 57/57 18/55 25/51 20/47 22/42 13/26 = no ED 100% 33% 49% 43% 52% 50% 60 or older and s0ll no ED ini-ally 6 weeks 6 Months 1 year 2 years 3years IIEF > 21 77/77 19/77 33/71 25/62 23/49 18/33 = no ED 100% 25% 47% 40% 47% 55% Half of the pts. will not develop an ED irrespec0ve of age!
18 Pa0ents with ini0ally normal potency younger than 60 years and then no or only mild ED ini-ally 6 weeks 6 Months 1 year 2 years 3years IIEF > 16 57/57 35/55 40/51 34/47 33/42 20/26 = no or mild ED 100% 64% 78% 72% 78% 77% 60 or older and aner PSI no or only mild ED ini-ally 6 weeks 6 Months 1 year 2 years 3years IIEF > 16 77/77 42/77 51/71 47/62 36/49 23/33 = no or mild ED 100% 55% 72% 76% 74% 70% ¾ of the pts. will s0ll have a quite good erec0le func0on irrespec0ve of age!
19 No or mild ED: < 60y vs 60y IIEF Sum: ini-al >16 (median values) IIEF 17-25, <60y (N=86-39) IIEF 17-25, 60y (N=172-75) Visite 0 Visite 1 Visite 2 Visite 3 Visite 4 Visite 5
20 Pa0ents with ini0ally mild or no ED younger than 60 years and no or only mild ED ini-ally 6 weeks 6 Months 1 year 2 years 3years IIEF > 16 86/86 46/82 51/76 46/69 41/58 27/39 = no or mild ED 100% 56% 67% 67% 71% 69% 2/3 of the younger pts. will s0ll have a quite good erec0le func0on 60 or older and no or only mild ED ini-ally 6 weeks 6 Months 1 year 2 years 3years IIEF > /172 64/168 80/160 84/145 62/117 37/75 = no or mild ED 100% 38% 50% 58% 53% 49% half of the older pts. will s0ll have a quite good erec0le func0on
21 Summary The preserva0on of erec0le func0on aner PSI should not be assessed in terms of yes or no The impact of PSI on erec0le func0on is dependent on pre- therapeu0c condi0on The majority of pa0ents will experience a slight drop of IIEF- score of about 5 points The subgroup of pts. without pre- exis0ng ED will have a sa0sfying sexual life aner PSI (irrespec0ve of age)
22 Simplified Summary Half of the pts. will stay in the same category of erec0le dysfunc0on ¾ of the pa0ents will stay in the same or 1 category lower e.g.: mild will be mild in 50% or mild to moderate in ¾ ¾ of the pa0ents will preserve a rather good or excellent erec0le func0on, if no there is no ED ini0ally
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