NEW YORK (Reuters Health) – Men with localized prostate cancer treated with external beam radiotherapy (EBRT) are apt to have better sexual function afterward than men treated with cryoablation, Canadian oncologists advise.

In their randomized trial, men in the EBRT arm reported better sexual function at 6 weeks post-treatment and continued to report better function at each assessment than men in the cryoablation arm, according to the researchers’ paper in the October 15 issue of Cancer.

With either treatment, patients “enjoyed a quality life similar to what they enjoyed prior to treatment. The one exception was sexuality,” Dr. John W. Robinson from University of Calgary and Tom Baker Cancer Center, Calgary, Alberta noted in an email to Reuters Health.

“Both treatments negatively affected the men’s sexual function, with those treated with cryosurgery being more negatively affected. Patients who want to increase their chances of maintaining sexual function might be counseled to choose radiotherapy over cryoablation,” he said.

Research has shown cryoablation to be as effective as EBRT in terms of disease progression and overall and disease-specific survival, the study team notes. “Consequently, differences in quality of life become important considerations in determining clinical benefit,” they write.

Dr. Robinson and his colleagues examined quality of life outcomes in 244 men with localized prostate cancer who were randomly assigned to cryoablation or EBRT (median dose 68 Gy). All patients received neoadjuvant androgen deprivation therapy.

With 36 months’ follow-up, regardless of treatment arm, men in the study reported high levels of quality of life with few exceptions. Cryoablation was associated with more acute urinary dysfunction (p < 0.001), which resolved over time. There were no late arising quality of life issues. Among men who were potent at baseline, both treatments led to declines in sexual function at 3 months post-treatment, with cryoablation patients reporting poorer sexual functioning (p < 0.001), the study team reports. At 3 years post-treatment, mean sexual function score was 15 points lower for men who had cryoablation, and 13% more of men in the cryoablation group reported that sexuality was a “moderate or big problem.” Also at 3 years, only 22% of men who had cryoablation reported having assisted or unassisted intercourse, compared with 36% of men who had EBRT. “We did not see the declines over time in sexual function in the EBRT study arm as reported in other studies, but we did see improvements over time in sexual function in the cryoablation study arm as previously reported,” the study team notes. Reference:
Cancer 2009;115:4695-4704.