Nursing Considerations in Brachytherapy-Related ED
Nursing Considerations in Brachytherapy-Related ED
Following definitive local treatment for early-stage prostate cancer, preservation of erectile function has been assumed to be most likely following brachytherapy. However, recent studies have demonstrated that brachytherapy-related erectile dysfunction (ED) is more common than initially reported. The exacerbation of brachytherapy-related ED is closely related to several clinical, treatment, and dosimetric parameters including pre-implant erectile function and radiation dose to the proximal penis. The majority of patients with brachytherapyinduced ED respond favorably to oral erectogenic agents.
Erectile dysfunction (ED) has been estimated to affect up to 30 million American men with a two to three-fold increase in the prevalence of moderate to severe ED between the ages of 40 and 70 (Feldman, Goldstein, Hatzichristou, Crane, & McKinlay, 1994; The National Institutes of Health [NIH] Consensus Conference, 1993). Erectile dysfunction has a proven deleterious effect on quality of life (QoL) including diminished physical and emotional well-being, marital discord, and loss of self-esteem (Burnett, 1998; Laumann, Paik, & Rosen, 1999; NIH, 1993). The NIH Consensus Conference defined ED as "the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance" and recommended the development of reliable Methods for assessing the symptoms of ED and evaluating treatment outcomes (NIH, 1993).
At the time of prostate cancer diagnosis, ED is present in 30% to 50% of men with a substantial number of additional men developing treatment-related ED (Karakiewicz, Aprikian, & Bazinet, 1997). Although it has been widely asserted that preservation of erectile function is more likely following brachytherapy, the incidence of brachytherapy-induced ED is substantially greater than initially reported (Merrick, Wallner, & Butler, 2003a). Subgroup analyses have demonstrated ED is present in 6% to 90% of patients undergoing brachytherapy. The wide ranges of reported ED likely reflect differences in followup, patient selection, implant technique, and the mode of data collection (Litwin, Lubeck, Henning, & Carroll, 1998; Merrick et al., 2003a). In general, those series with longest followup or the utilization of patient-administered questionnaires report lower rates of potency preservation (Merrick et al., 2003a). Fortunately, most patients with brachytherapyinduced ED respond favorably to oral erectogenic agents such as sildenafil citrate (Merrick et al., 1999).
Summary and Introduction
Summary
Following definitive local treatment for early-stage prostate cancer, preservation of erectile function has been assumed to be most likely following brachytherapy. However, recent studies have demonstrated that brachytherapy-related erectile dysfunction (ED) is more common than initially reported. The exacerbation of brachytherapy-related ED is closely related to several clinical, treatment, and dosimetric parameters including pre-implant erectile function and radiation dose to the proximal penis. The majority of patients with brachytherapyinduced ED respond favorably to oral erectogenic agents.
Introduction
Erectile dysfunction (ED) has been estimated to affect up to 30 million American men with a two to three-fold increase in the prevalence of moderate to severe ED between the ages of 40 and 70 (Feldman, Goldstein, Hatzichristou, Crane, & McKinlay, 1994; The National Institutes of Health [NIH] Consensus Conference, 1993). Erectile dysfunction has a proven deleterious effect on quality of life (QoL) including diminished physical and emotional well-being, marital discord, and loss of self-esteem (Burnett, 1998; Laumann, Paik, & Rosen, 1999; NIH, 1993). The NIH Consensus Conference defined ED as "the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance" and recommended the development of reliable Methods for assessing the symptoms of ED and evaluating treatment outcomes (NIH, 1993).
At the time of prostate cancer diagnosis, ED is present in 30% to 50% of men with a substantial number of additional men developing treatment-related ED (Karakiewicz, Aprikian, & Bazinet, 1997). Although it has been widely asserted that preservation of erectile function is more likely following brachytherapy, the incidence of brachytherapy-induced ED is substantially greater than initially reported (Merrick, Wallner, & Butler, 2003a). Subgroup analyses have demonstrated ED is present in 6% to 90% of patients undergoing brachytherapy. The wide ranges of reported ED likely reflect differences in followup, patient selection, implant technique, and the mode of data collection (Litwin, Lubeck, Henning, & Carroll, 1998; Merrick et al., 2003a). In general, those series with longest followup or the utilization of patient-administered questionnaires report lower rates of potency preservation (Merrick et al., 2003a). Fortunately, most patients with brachytherapyinduced ED respond favorably to oral erectogenic agents such as sildenafil citrate (Merrick et al., 1999).