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(056) Characterizing Corporovenocclusive Dysfunction in Men After Radiation Therapy for Prostate Cancer

Year: 2024
Type: article
Study design: Observational Study
Abstract: Introduction Radiation therapy (RT) for prostate cancer (PC) often leads to erectile dysfunction (ED). Objective We aimed to characterize corporvenocclusive dysfunction (CVOD) rates in men following RT for PC. Methods Study population consisted of (i) men after RT with or without androgen deprivation therapy (ADT) (ii) who developed ED (iii) with poor response to PDE5i and ICI, (iv) who had penile duplex Doppler ultrasound (DUS) (v) using a vasoactive agent redosing schedule. Arterial insufficiency (AI) was defined using a peak systolic velocity (PSV) <30 cm/sec bilaterally and CVOD using end diastolic velocity (EDV) values ≥5 cm/sec bilaterally. Demographics, comorbidity, endocrine profiles and DUS parameters were recorded. The erection hardness scale (EHS) was used to evaluate ED before RT (1-4, 4 hardest erection). We used univariate (UV) and multivariable analyses (MV) to define factors predictive of CVOD. Variables included in the UV model: age, comorbid conditions (diabetes (DM), hyperlipidemia (HLD), obstructive sleep apnea (OSA), coronary artery disease (CAD), hypertension (HTN)), RT type - brachy (BT) vs external beam (EBRT), RT dose, EHS, and ADT duration. Factors that were significant on UV analysis moved forward into the MV model. Results 156 men were analyzed. Median age was 69 (62, 74) years. Median RT dose 7020 (4000,10 000) Gy with 57% of men receiving EBRT and 43% received BT. 54% received ADT, with a median exposure of 15 (6, 24) months. 33% received ADT for ≥12 months. 4% had ≥3 vascular comorbidities: DM 21%, OSA 25%, smoking 47%. Median pre-RT EHS score 4 (3,4), 20% being ≤2. Median baseline PSA was 3.5 (0.4, 6) ng/mL. Pre-RT total testosterone (T) was 14 (8, 313) ng/dL. Median total T at the time of DUS was 350 (207, 457) ng/dL and 46% had low T. Median trimix dose administered at DUS was 75 (20, 100) units. 50% received 100 units. Median PSV was 43 (33, 56) cm/sec, median EDV 8 (0, 12) cm/sec. Erection reversal was requirted in 36% of men. CVOD was diagnosed in 59%. AI was diagnosed in 14%, CVOD+AI was observed in 7% of cases. On MV, the predictors of CVOD were older age, ADT duration ≥12 months, dyslipidemia (Table). Conclusions In men after RT for PC, CVOD was present in more than half of patients studied, with three significant predictors identified. Disclosure No.
DOI: 10.1093/jsxmed/qdae167.054
Language: English
Field: Medicine
Open Access status: bronze
OpenAlex ID: W4405221775
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