Late complications

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Late complications of PB include irritative voiding symptoms, persistent urinary retention, rectal urgency, bowel frequency, rectal bleeding or ulceration, and prostatorectal fistulas.38-41 In one series, 19 of 109 patients (19%) developed persistent, bright-red rectal bleeding, from 1 to 28 months following 125I implantation.42 Urinary retention requiring intermittent or long-term urinary catheterization is uncommon, occurring in fewer than 5%.43 In a second report of 105 men treated an average of 5.2 years before survey, bowel symptoms were uncommon (4-9%) unless external beam irradiation had also been administered.38

Compared to 3D-CRT, PB is associated with both more acute and chronic urinary morbidity. This was illustrated in one series that compared outcomes in men with favorable risk prostate cancer who received either 3D-CRT (n = 137) or transperineal 125I implantation (n = 145).7 In the PB group, 31% had grade 2 urinary symptoms persisting after 1 year, and the median duration of grade 2 urinary symptoms was 23 months (range 12-70 months). In contrast, acute grade 2 urinary symptoms resolved within 4-6 weeks after completion of 3D-CRT, and at 5 years, only 8% still had ^ grade 2 urinary toxicity. The 5-year likelihood of post-treatment erectile dysfunction among patients who were initially potent before therapy was similar between the two groups, as was the 5-year likelihood of grade 2 late rectal toxicity (6% and 11%, respectively, for 3D-CRT and PB). The impact of brachytherapy on potency was evaluated in several reports38,44,45 as follows.

• In one series, 416 men underwent radioactive seed implantation for T1-2 prostate cancer.44 In the 313 men who were potent prior to treatment, potency was retained in 79% at 3 years and 59% at 6 years.

• Similar results were noted in a second review of 482 men who were potent before treatment.45 At 5 years, potency was preserved overall in 53%; 76% of those treated with PB monotherapy maintained potency.

• In a third report surveying patient-reported symptoms at an average of 5.2 years following treatment, complete impotence (51%) and erections inadequate for penetration without manual assistance (72%) were seen in men who had full erections at baseline.38.

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Dealing With Erectile Dysfunction

Dealing With Erectile Dysfunction

Whether you call it erectile dysfunction, ED, impotence, or any number of slang terms, erection problems are something many men have to face during the course of their lifetimes.

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