Sildenafil citrate effectively reverses sexual dysfunction induced by three-dimensional conformal radiation therapy.

OBJECTIVES: We evaluated the response of sildenafil citrate in patients with prostate cancer treated with three-dimensional conformal radiation therapy (3DCRT) whose sexual function (SF) was known prior to therapy initiation. METHODS: From March 1996 to April 1999, 24 men with median age of 68 years (range 51 to 77) had 3DCRT for localized prostate cancer (median prescribed dose to the planning target volume of 70.2 Gy). These men started taking sildenafil for relief of sexual dysfunction at a median time of 1 year after completing 3DCRT. We used the self-administered O'Leary Brief Sexual Function Inventory to evaluate in series SF and overall satisfaction at three time points. These points were (a) before initiation of all therapies (3DCRT or hormonal treatment [HT]) for prostate cancer, (b) before starting sildenafil (50 mg or 100 mg) but after completion of all therapies, and (c) at least 2 months afterward. Rates of SF were based on the number of men responding to a given question. We tested for significance of these two interventions to change SF by applying the Wilcoxon sign rank test. RESULTS: Prior to all treatments, 20 (87%) of 23 men were sexually potent, with 8 (36%) of 22 fully potent (little or no difficulty for penetration at intercourse). After 3DCRT with or without HT and prior to sildenafil use, 13 (65%) of the 20 potent patients remained potent, with only 2 (11%) of 19 being fully potent. The use of sildenafil citrate resulted in 21 (91%) of 23 men being potent, with 7 (30%) being fully potent. In 16 men responding to the satisfaction question, 10 (63%) and 12 (75%) were mixed to very satisfied with their sex life before 3DCRT with or without HT and after sildenafil citrate use, respectively. This response corresponded to potency and satisfaction scores significantly decreasing and subsequently increasing on average by one unit after 3DCRT and sildenafil citrate use, respectively (P <0.05). CONCLUSIONS: In men receiving 3DCRT for prostate cancer, these data indicate that sildenafil citrate is effective for restoring SF and associated satisfaction back to baseline before treatment.

Surgical staging in carcinoma of the prostate: the RTOG experience. Radiation Therapy Oncology Group.

One hundred thirty-six patients with carcinoma of the prostate entered on phase III RTOG studies (RTOG 75-06 and RTOG 77-06) between 1976 and the end of 1980 underwent staging lymphadenectomy prior to irradiation. The operative reports and histological findings have been reviewed in order to determine the patterns of intrapelvic tumor spread and to correlate the type of surgical procedure and the extent of lymphatic dissection with the incidence and type of postirradiation complications (primarily genital and lower extremity lymphedema). The surgical procedures were classified into three categories according to extent: 1) biopsy only, 2) limited (diagnostic) dissection, and 3) complete (therapeutic) dissection. The incidence of postirradiation lymphedema was found to be strongly dependent upon the extent of dissection. Patients undergoing limited (diagnostic) dissection followed by pelvic irradiation have a 25-30% risk of developing this debilitating complication. In patients undergoing complete (therapeutic) dissection followed by pelvic irradiation lymphedema has been observed in 66% of cases.