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IMPOTENCE AND PROSTATE CANCER

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 Men with prostate cancer are just as likely to develop
impotence with radiation therapy as they are with surgical
removal of the prostate gland, a new study suggests. Yet, the new
findings seem to contradict previous research, which has found
that radiation treatment has a lower risk of sexual dysfunction,
experts caution.

"I think our data are a long first step at showing that
differences [in impotence rates] aren't going to be dramatically
different," said lead author Dr. James Talcott, an assistant
professor of medicine at Harvard Medical School in Boston.

"People getting treatment for prostate cancer should expect
to be impotent eventually. Some won't, but most will," said
Talcott, who presented his findings this week at the American
Society of Therapeutic Radiology and Oncology meeting in Los
Angeles. "The difference doesn't appear big enough to be
using as a basis for choosing treatment."

According to a survey of 260 men, about 96% were impotent three
months after a radical prostatectomy -- a complete surgical
removal of the prostate -- compared to only 58% of men after
radiation treatment. One year later, 93% of surgical patients
were impotent, as were 67% of radiation patients. But two years
after the treatment, 85% of surgical patients were impotent and
88% of radiation group experienced sexual dysfunction.

However, those who underwent radiation were slightly older --
about 68 year of age versus 62 years of age -- compared to those
having surgery, and were more likely to be impotent before the
treatment began (45% versus 32%).

"The character of impotence for radiation therapy patients
is a little different from surgery patients -- who tend to be
completely impotent," said Talcott. "Radiation therapy
patients commonly have erections which are not firm enough for
sexual activity."

Impotence worsens over time for patients who have radiation
therapy because of the development of scar tissue, according to
the Boston researcher.

"With radiation it starts off well, but over time the
scarring it produces has effects," he said. Scarring can
damage nerves and blood vessels that direct blood flow into the
penis or may interfere with valves that maintain an erection by
preventing blood from leaving the penis, according to Talcott.

However, a second study also presented at the meeting found that
of 45 patients between 50 and 65 years of age, only 27% of men
who functioned sexually before radiation therapy were impotent
three years after radiation therapy.

"I don't know what [Talcott's] data means; I can't reconcile
the two," said study co-author Dr. Gerald Hanks, chairman of
the department of radiation oncology at Fox Chase Cancer Center
in Philadelphia.

The best advice for men with a diagnosis of prostate cancer is to
discuss all their treatment options with their doctor, according
to Talcott. Many times prostate cancer grows very slowly and can
be treated with "watchful waiting" -- monitoring of the
cancer while taking no further action.

"It is useful for many men to think of prostate cancer as a
disease less like lung cancer or acute leukemia, which kills you
quickly, and perhaps more like a diagnosis of diabetes or heart
disease," he said. "You are not looking down the barrel
of a gun."

November 02, 1996
14:48 +0000

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