Department of Radiation Oncology, University of Florence, Florence, Italy.
Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands.
J Sex Med. 2019 Sep;16(9):1409-1420. doi: 10.1016/j.jsxm.2019.05.019. Epub 2019 Jul 11.
Sexual function can be impaired by all prostate cancer treatment modalities, but studies specifically addressing the impact of stereotactic body radiotherapy (SBRT) on sexual function are scarce.
To systematically evaluate sexual outcomes in patients treated by SBRT for prostate cancer and determine clinical factors associated with erectile dysfunction (ED).
A systematic review of the available literature was performed on PubMed/Medline, Scopus, and Cochrane Library databases in June 2017 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Only articles providing data on baseline and post-treatment sexual function after SBRT (≥5 Gy/fraction) were included in this analysis (n = 12).
Sexual function deteriorates after SBRT of the prostate.
Deterioration of sexual health was found, with Expanded Prostate Cancer Index Composite-26 sexual domain scores showing a median decrease of 9.2 at 12 months and a median decrease of the Sexual Health Inventory for Men subdomain score by 2.7 at 12 months (from baseline median value of 56.3 and 16, respectively). At 60 months, ED was reported by 26-55% of previously sexually functioning patients in 5 of the 12 studies.
ED affects ≤55% of previously sexually functioning patients at 5 years, as reported for other non-surgical treatment modalities.
STRENGTHS & LIMITATIONS: This study enforced strict inclusion criteria of selected studies and exclusion of patients receiving concurrent androgen deprivation therapy. However, inconsistencies in the choice of assessment tool and definition of ED hamper a robust meta-analysis of pooled data.
Sexual function decline after SBRT for prostate cancer appears to be similar to other modalities and should be specifically addressed in future studies. Loi M, Wortel RC, Francolini G, et al. Sexual Function in Patients Treated With Stereotactic Radiotherapy For Prostate Cancer: A Systematic Review of the Current Evidence. J Sex Med 2019;16:1409-1420.
所有前列腺癌治疗方法都可能损害性功能，但专门研究立体定向体放射治疗（SBRT）对性功能影响的研究很少。
系统评估接受 SBRT 治疗前列腺癌患者的性功能，并确定与勃起功能障碍（ED）相关的临床因素。
根据系统评价和荟萃分析报告的首选报告项目，于 2017 年 6 月在 PubMed/Medline、Scopus 和 Cochrane 图书馆数据库中对现有文献进行了系统评价。只有提供 SBRT（≥5 Gy/分数）后基线和治疗后性功能数据的文章才包括在本分析中（n=12）。
前列腺 SBRT 后性功能恶化。
发现性功能健康恶化，扩展前列腺癌指数综合 26 项性领域评分在 12 个月时中位数下降 9.2，男性健康问卷性领域评分中位数下降 2.7 在 12 个月时（分别从基线中位数 56.3 和 16）。在 12 项研究中的 5 项研究中，有 26%-55%的以前性功能正常的患者在 60 个月时报告出现 ED。
如其他非手术治疗方法报道，5 年内 ED 影响≤55%的以前性功能正常的患者。
本研究严格执行选定研究的纳入标准，排除同时接受雄激素剥夺治疗的患者。然而，评估工具的选择和 ED 的定义不一致，阻碍了对汇总数据的稳健荟萃分析。
SBRT 治疗前列腺癌后性功能下降似乎与其他治疗方法相似，应在未来的研究中专门探讨。
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