Timothy Zagar, Presenter: Nothing to Disclose

Richard Glenn Stock MD, Abstract Co-Author: Nothing to Disclose

Nelson Neal Stone MD, Abstract Co-Author: Nothing to Disclose

Purpose/Objective: Erectile dysfunction (ED) remains an undesirable side effect in many men following treatment for prostate cancer. To overcome physician bias in assessment of potency following treatment, patient-assessed validated questionnaires were developed. The Mount Sinai Erectile Function Score (MSEFS) (a physician-assigned potency rating) was developed for our brachytherapy program starting in 1990 (J. Urol., 165: 436-439, 2001). In 1998, patients were asked to independently fill out the Sexual Health Inventory for Men (SHIM) as part of their evaluation and follow-up. This study compares the two methods of assessment and describes potency following brachytherapy. Materials/Methods: Between 1990 and 2003, 538 patients with T1 or T2 prostate cancer were treated with ultrasound-guided radioactive seed implantation without external beam irradiation and had a least one visit where both MSEFS and SHIM assessment were completed. At each of the 1,287 visits, patients were assigned a MSEFS ranging from 0 to 3 (0: no erections, 1: ability to have erections but insufficient for vaginal penetration, 2: erectile function sufficient for vaginal penetration but suboptimal, 3: normal erectile function) and filled out a SHIM with a possible maximum total score of 25 (severe ED (1 to 7), moderate ED (8 to 11), mild to moderate ED (12 to 16), mild ED (17 to 21), no ED (22 to 25)). Correlations were performed using the Spearman rho test . Follow-up visits were done at 6-month intervals, ranging from 1 to 148 months, median 32 months. Results: The MSEFS significantly correlated with the total SHIM scores on all comparisons with p values <0.001. The coefficient was 0.61 for comparisons done on the initial consultation date and 0.71 for all visits. On subsequent follow up visits, the correlations got stronger. The correlation coefficients for visits 1 through 7 were: 0.69, 0.74, 0.76, 0.84, 0.80, 0.80, and 0.87. 320 patients were assigned to be potent (MSEFS of 2 or 3) before brachytherapy. Of the 320, 246 patients (77%) remained potent as defined by their MSEFS at last visit. The corresponding last SHIM scores for these patients were: 1 to 7 in 28%, 8 to 11 in 8%, 12 to 16 in 20%, 17 to 21 in 23% and 22 to 25 in 22%. Conclusions: Our physician-assigned potency scale correlates well with the SHIM. The SHIM, completed by the patient, supplements, but does not replace, the physician scale in assessing ED.

Zagar, T, Stock, R, Stone, N, Assessment of Post-Brachytherapy Sexual Function: A Comparison of Two Erectile Dysfunction Inventory Instruments.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4417901.html