Presentation Authors: HOSSEIN SADEGHI-NEJAD*, DENNIS FRIED, EAST ORANGE, NJ, DIAN GU, SHOUHAO ZHOU, WEIGUO HE, SHARON GIORDANO, HOUSTON, TX, DREW HELMER, EAST ORANGE, NJ, CHAN SHEN, HOUSTON, TX
Introduction: Sexual health problems affect approximately 60% of male cancer survivors in the U.S. Erectile dysfunction (ED) is the most common sexual health problem leading men to seek professional help after cancer treatment with some studies reporting ED rates as high as 85%. Inflatable penile prosthesis (IPP) implantation is a safe and effective form of ED treatment for those patients who fail or cannot tolerate medical therapies. A 2011 study reported that less than 1% of men with prostate cancer and ED received IPP following radical prostatectomy or external beam radiation, suggesting that IPPs are under-utilized by urologists. To better characterize the utilization of this treatment, we examined the relationships between ED, prostate cancer treatment type and IPP implantation in a national cohort.
Methods: We used a retrospective cohort of older SEER-Medicare patients who were diagnosed with local/regional prostate cancer between 2006 and 2009 and treated with surgery or radiation for it, with and without ED. Receipt of surgery or radiation within 3 months of diagnosis as well as diagnosed ED 5-years after undergoing treatment, were both ascertained from ICD9/CPT/HCPCS codes. Chi-square/Wilcoxon tests were used to detect significant differences between the surgical and radiation treatment groups for ED rates and use of IPP among those with ED.
Results: Among the 21,258 patients in our cohort, 5,775 (27.2%) received surgery and 15,483 (72.8%) received radiation. Overall, ED was significantly more common for surgical (62.4%) than for radiation patients (30.6%, p < .0001). For the subset of 8,343 patients with ED (overall IPP use=2.5%), IPP implantation was significantly more frequent for surgical patients (n=3,601, IPP use= 3.7%) than for radiation patients (n=4,742, IPP use=1.5%, p < .0001).
Conclusions: Surprisingly few (2.5%) prostate cancer patients with ED received IPP. Even more noteworthy, only 1.5% of radiation patients received IPP (vs. 3.7% of surgical patients). IPP under-utilization may be due to greater clinical focus on cancer treatment rather than quality-of-life issues. Discrepancies in ED rates between radiation and surgery may at least be partially explained by lack of standardization and highly variable sexual dysfunction reporting, particularly in the radiation literature, as recently published. These findings highlight the importance of thorough counseling about all treatment options including penile prosthesis surgery for prostate cancer patients with ED.