(415) Comparison of Satisfaction With Penile Prosthesis Implantation in Patients With Prostate Cancer Radiation Therapy versus Radical Prostatectomy or Radical Cystoprostatectomy
Authors: Mehr J , Green T , Howell S , Palasi S , Sullivan A , Kim B , Kannady C , Khalafalla K , Wang R 
Published: May 2023

Abstract

Introduction
Penile Prosthesis Surgery (PPS) is a commonly used treatment for Erectile Dysfunction (ED), either as first-line therapy or in cases refractory to other treatment options. In patients with urologic malignancies, such as prostate or bladder cancer, surgical interventions like radical prostatectomy (RP) and radical cystoprostatectomy (RCP) as well as alternative treatments such as radiation therapy can all induce ED. PPS as a treatment for ED has high satisfaction rates in the general population. There is limited data available on sexual satisfaction in patients with prosthesis implantation for ED following RP/RCP versus ED following radiation therapy for prostate cancer.

Objective
The primary objective for our study was to determine if there is a significant difference in device and sexual satisfaction rates between patients receiving PPS for ED post-RP/RCP versus post-prostate cancer radiation therapy quantified via a validated questionnaire.

Methods
A retrospective chart review from our institutional database was conducted to identify 970 patients who underwent PPS at our institution from 2011 to 2021. Only patients that had Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire data at least 6 months from implant operative date available were included. Eligible patients were screened and placed in one of two groups depending on etiology of ED- following RP/RCP or following prostate cancer radiation therapy. To prevent crossover confounding; patients with history of pelvic radiation were excluded from the RP/RCP group and patients with history of RP/RCP were excluded from the radiation group. Data was obtained from 73 patients in the RP/RCP group (RP=66, RCP=7) and 32 patients in the radiation therapy group (Extended Beam Radiation Therapy (EBRT) = 26, Brachytherapy=6). Demographics, surgical information, etiology of ED, and penile doppler results were recorded for both groups. EDITS questionnaire responses were compared between the two groups as a measurement of device and sexual satisfaction. Additional subgroup analysis was conducted between RP and RCP patients. P&lt;0.05 was statistically significant.

Results
There was a significant difference in mean survey responses for all 11 questions in the EDITS questionnaire between the RP/RCP group and the radiation group. Specifically, the RP/RCP group had a significantly higher mean score in questions surveying overall satisfaction (p=0.01), level to which device has met their expectations (p=0.03), as well as confidence in engaging in sexual activity with their partner (p&lt;0.001). Additional survey questions administered also found RP/RCP patients reported significantly higher rate of satisfaction with size of penis post-operatively versus the radiation group (p=0.01). Subgroup analysis found no difference in satisfaction (p=0.16), device expectations (p=0.37), or confidence in engaging in sexual activity (p=0.82) between the RP and RCP groups.

Conclusions
These preliminary findings, while requiring large-scale follow up, suggest that there is greater sexual satisfaction and penile prosthesis device satisfaction in patients undergoing IPP placement following RP/RCP versus radiation therapy for prostate cancer. Use of validated questionnaires should continue to be utilized in quantifying device and sexual satisfaction following penile prosthesis placement.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Run Wang, MD, FACS is a consultant for Boston Scientific, Coloplast, and Teleflex.