TY - JOUR
T1 - The Natural History of Erectile Dysfunction After Prostatic Radiotherapy
T2 - A Systematic Review and Meta-Analysis
AU - Gaither, Thomas W.
AU - Awad, Mohannad A.
AU - Osterberg, E. Charles
AU - Murphy, Gregory P.
AU - Allen, Isabel E.
AU - Chang, Albert
AU - Rosen, Raymond C.
AU - Breyer, Benjamin N.
N1 - Publisher Copyright:
© 2017 International Society for Sexual Medicine
PY - 2017/9
Y1 - 2017/9
N2 - Background Erectile dysfunction (ED) after treatment for prostate cancer with radiotherapy (RT) is well known, and pooled estimates of ED after RT will provide more accurate patient education. Aim To systematically evaluate the natural history of ED in men with previous erectile function after prostate RT and to determine clinical factors associated with ED. Methods We performed a review of the PubMed and Medline, Embase, Cochrane Library, and Web of Science databases in April 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports included a measurement of ED before and after prostate RT. Two hundred seventy-eight abstracts were screened and 105 publications met the criteria for inclusion. Only men with known erectile function before RT were included in the analysis. Outcome ED after RT of the prostate. Results In total, 17,057 men underwent brachytherapy (65%), 8,166 men underwent external-beam RT (31%), and 1,046 men underwent both (4%). Seven common instruments were used to measure ED, including 23 different cutoffs for ED. The Sexual Health Inventory for Men (SHIM) was used in 31 studies (30%). Pooled estimates of SHIM-confirmed ED (score <10–17) suggested the prevalence of ED after RT is 34% of men (95% CI = 0.29–0.39) at 1 year and 57% (95% CI = 0.53–0.61) at 5.5 years. Compared with brachytherapy, studies of the two types of radiation increased the proportion of new-onset ED found by 12.3% of studies (95% CI = 2.3–22.4). For every 10% who were lost to follow-up, the proportion of ED reported increased by 2.3% (95% CI = 0.03–4.7). Clinical Implications ED is common regardless of RT modality and increases during each year of follow-up. Using the SHIM, ED is found in approximately 50% patients at 5 years. Strengths and Limitations The strengths of this systematic review include strict inclusion criteria of studies that measured baseline erectile function, no evidence for large effect size bias, and a large number of studies, which allow for modeling techniques. However, all data included in this analysis were observational, which leaves the possibility that residual confounding factors increase the rates of ED. Conclusion Definitions and measurements of ED after RT vary considerably in published series and could account for variability in the prevalence of reported ED. Loss to follow-up in studies could bias the results to overestimate ED. Gaither TW, Awad MA, Osterberg EC, et al. The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis. J Sex Med 2017;14:1071–1078.
AB - Background Erectile dysfunction (ED) after treatment for prostate cancer with radiotherapy (RT) is well known, and pooled estimates of ED after RT will provide more accurate patient education. Aim To systematically evaluate the natural history of ED in men with previous erectile function after prostate RT and to determine clinical factors associated with ED. Methods We performed a review of the PubMed and Medline, Embase, Cochrane Library, and Web of Science databases in April 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports included a measurement of ED before and after prostate RT. Two hundred seventy-eight abstracts were screened and 105 publications met the criteria for inclusion. Only men with known erectile function before RT were included in the analysis. Outcome ED after RT of the prostate. Results In total, 17,057 men underwent brachytherapy (65%), 8,166 men underwent external-beam RT (31%), and 1,046 men underwent both (4%). Seven common instruments were used to measure ED, including 23 different cutoffs for ED. The Sexual Health Inventory for Men (SHIM) was used in 31 studies (30%). Pooled estimates of SHIM-confirmed ED (score <10–17) suggested the prevalence of ED after RT is 34% of men (95% CI = 0.29–0.39) at 1 year and 57% (95% CI = 0.53–0.61) at 5.5 years. Compared with brachytherapy, studies of the two types of radiation increased the proportion of new-onset ED found by 12.3% of studies (95% CI = 2.3–22.4). For every 10% who were lost to follow-up, the proportion of ED reported increased by 2.3% (95% CI = 0.03–4.7). Clinical Implications ED is common regardless of RT modality and increases during each year of follow-up. Using the SHIM, ED is found in approximately 50% patients at 5 years. Strengths and Limitations The strengths of this systematic review include strict inclusion criteria of studies that measured baseline erectile function, no evidence for large effect size bias, and a large number of studies, which allow for modeling techniques. However, all data included in this analysis were observational, which leaves the possibility that residual confounding factors increase the rates of ED. Conclusion Definitions and measurements of ED after RT vary considerably in published series and could account for variability in the prevalence of reported ED. Loss to follow-up in studies could bias the results to overestimate ED. Gaither TW, Awad MA, Osterberg EC, et al. The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis. J Sex Med 2017;14:1071–1078.
KW - Erectile Dysfunction
KW - Prostate Cancer
KW - Radiation Therapy
KW - Sexual Health Inventory for Men (SHIM)
UR - http://www.scopus.com/inward/record.url?scp=85028457768&partnerID=8YFLogxK
U2 - 10.1016/j.jsxm.2017.07.010
DO - 10.1016/j.jsxm.2017.07.010
M3 - Review article
C2 - 28859870
AN - SCOPUS:85028457768
SN - 1743-6095
VL - 14
SP - 1071
EP - 1078
JO - Journal of Sexual Medicine
JF - Journal of Sexual Medicine
IS - 9
ER -