Long-term outcomes following proton therapy for prostate cancer in young men with a focus on sexual health

• Published in: Acta oncologica 2018-05, Vol.57 (5), p.582-588
• Main Authors: Ho, Clement K, Bryant, Curtis M, Mendenhall, Nancy P, Henderson, Randal H, Mendenhall, William M, Nichols, Romaine C, Morris, Christopher G, Kanmaniraja, Dvaraju, Hamlin, Derek J, Li, Zuofeng, Hoppe, Bradford S
• Format: Article
• Language: English
• Subjects: Adult; Humans; Male; Middle Aged; Prostatic Neoplasms - radiotherapy; Proton Therapy - adverse effects; Quality of Life; Sexual Dysfunction, Physiological - epidemiology; Sexual Dysfunction, Physiological - etiology; Sexual Health; Treatment Outcome
• ISSN: 0284-186X; 1651-226X
• DOI: 10.1080/0284186X.2018.1427886

We investigated long-term outcomes for men ≤60 years old treated with proton therapy (PT). Of 254 men ≤60 years old were treated with proton therapy alone for prostate cancer. Risk stratification included 56% with low-, 42% with intermediate- and 2% with high-risk disease. Patients received 76-82 Gy at 2 Gy/fraction or 70-72.5 Gy at 2.5 Gy/fraction. Before treatment and every 6-12 months for 5 years, patients were evaluated by a physician, answered health-related quality of life surveys, including the EPIC, IIEF and IPSS, and had PSA evaluated. Median follow-up for the cohort was 7.1 years; 7-year biochemical-free survival was 97.8%. Eight men (one high-risk; five intermediate-risk and two low-risk) experienced biochemical progression, including one who died of disease 9 years after treatment. Potency (erections firm enough for sexual intercourse) was 90% at baseline and declined to 72% at the first-year follow-up, but declined to only 67% at 5 years. Only 2% of patients developed urinary incontinence requiring pads. The bowel habits mean score declined from a baseline of 96 to 88 at 1 year, which improved over the following years to 93 at 5 years. Young men with prostate cancer continue to have excellent results with respect to 7-year biochemical control and 5-year erectile function, without clinically significant urinary incontinence 5 years after proton therapy. Comparative effectiveness studies of proton therapy with surgery and IMRT are needed.