Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.
Julius L. Chambers Biomedical Biotechnology Research Institute, North Carolina Central University, Durham, NC, USA.
J Sex Med. 2022 May;19(5):771-780. doi: 10.1016/j.jsxm.2022.02.018. Epub 2022 Mar 17.
Ejaculatory dysfunction is an important male quality of life issue which has not yet been studied in the setting of prostate stereotactic body radiation therapy (SBRT).
The purpose of this study is to evaluate ejaculatory function following SBRT for prostate cancer.
Two hundred and thirty-one patients on a prospective quality of life study with baseline ejaculatory capacity treated with prostate SBRT from 2013 to 2019 were included in this analysis. Ejaculation was assessed via the Ejaculation Scale (ES-8) from the Male Sexual Health Questionnaire. Patients completed the questionnaire at 1, 3, 6, 9, 12, 18, and 24 months post-SBRT. Elderly patients (Age > 70) and those who received hormonal therapy were excluded from analysis. Patients were treated to 35-36.25 Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray).
Ejaculatory function was assessed by ES-8 scores (range 4-40) with lower values representing increased interference or annoyance.
Median age at the time of treatment was 65 years. Median follow up was 24 months (IQR 19-24.5 months). 64.5% of patients had ED at baseline (SHIM < 22). The 2-year anejaculation rate was 15%. Mean composite ES-8 scores showed a decline in the first month following treatment then stabilized: 30.4 (start of treatment); 26.5 (1 month); 27.6 (3 month); 27.0 (6 month); 26.2 (9 month); 25.4 (12 month); 25.0 (18 month) and 25.4 (24 month). White race, higher pre-treatment SHIM (≥22), and higher ES-8 (≥31) at treatment start were significantly associated with a decreased probability of a clinically significant decline. Patient-reported ejaculate volume was significantly reduced at all time points post-SBRT. Ejaculatory discomfort peaked at 1 month and 9 months post-SBRT. Prior to treatment, 8.0% of men reported that they were very to extremely bothered by their ejaculatory dysfunction. The number of patients reporting this concern increased to 14.4% at one year and dropped to 11% at 24-months post-SBRT.
Patients undergoing prostate SBRT may experience meaningful changes in ejaculatory function and should be counseled on the trajectory of these side effects.
STRENGTHS & LIMITATIONS: This was a retrospective analysis of a prospectively maintained database. Subjective questionnaire responses captured limited aspects of ejaculatory function in this cohort.
The high incidence of moderate to extreme bother in ejaculatory function before and after SBRT suggests a need for novel approaches to improving ejaculation. Sholklapper T, Creswell M, Cantalino J, et al. Ejaculatory Function Following Stereotactic Body Radiation Therapy for Prostate Cancer. J Sex Med 2022;19:771-780.
射精功能障碍是男性生活质量的一个重要问题，但在前列腺立体定向体部放射治疗（SBRT）的环境中尚未进行研究。
本研究旨在评估前列腺 SBRT 治疗后射精功能。
2013 年至 2019 年，我们对 231 名接受前列腺 SBRT 治疗且基线射精能力的前瞻性生活质量研究患者进行了分析。射精通过男性性健康问卷中的射精量表（ES-8）进行评估。患者在 SBRT 后 1、3、6、9、12、18 和 24 个月完成问卷。排除年龄>70 岁的老年患者和接受激素治疗的患者。患者接受 35-36.25 Gy 的 5 次分割治疗，使用 CyberKnife 放射外科系统（Accuray）进行治疗。
射精功能通过 ES-8 评分（范围 4-40）进行评估，评分越低表示干扰或烦恼越大。
SBRT 前后射精功能中度至极度困扰的发生率较高，表明需要采用新方法改善射精。
这是对前瞻性维护数据库的回顾性分析。在这个队列中，主观问卷反应仅捕捉到射精功能的有限方面。
