therapy administered prior and following external beam radi-ation therapy in localized prostate cancer. Int J Radiat OncolBiol Phys, 37: 247, 1997

17. Pilepich, M. V., Krall, J. M., al-Sarraf, M., John, M. J., Doggett,R. L., Sause, W. T. et al: Androgen deprivation with radiationtherapy compared with radiation therapy alone for locallyadvanced prostatic carcinoma: a randomized comparative trialof the Radiation Therapy Oncology Group. Urology, 45: 616,1995

EDITORIAL COMMENT

The authors present a longitudinal analysis of sexual function inmen undergoing prostate brachytherapy or 3-D conformal radiationtherapy at 2 academic medical centers. They conclude that in theabsence of LH-RH agonist use these 2 treatments have similareffects on sexual function 1 to 2 years after therapy.

Does this mean that patients who are choosing between brachy-therapy and 3-D conformal radiation therapy can expect similarpotency rates regardless of treatment choice? The answer is proba-bly. The reader must remember that the authors did not examinepotency rates per se but rather performed an actuarial analysis oftime to return to baseline. While this is statistically sound, it mayhave clinical implications. Treatment failure would be considered inan individual who initially presents with “very good” erectile func-tion (response 4 to the erectile function item of the UCLA ProstateCancer Index) and then reports “good” erectile function (response 3)1 year after treatment, as erectile function did not return to baseline.While this may not have had much effect on the analysis of overall

satisfaction (where the 2 study groups were quite similar at base-line), the same may not be true for the analysis of erectile function.When queried about baseline erectile function, 56% of the men un-dergoing 3-D conformal radiation therapy reported “poor” function,while only 18% undergoing brachytherapy gave a similar response.Therefore, it may have been somewhat easier for patients receiving3-D conformal radiation therapy to return to baseline, which couldhave biased the study.

While there may be some debate as to whether isolated 3-D con-formal radiation therapy or brachytherapy was associated withworse sexual function after treatment, there is little doubt that theaddition of long-term adjuvant LH-RH agonist therapy had a dele-terious effect on potency. This finding is confirmed by the fact thatonly 31% of men who underwent brachytherapy combined with 8 to9 months of adjuvant LH-RH agonist therapy and boost externalbeam radiotherapy reported return to baseline, compared to 51%who received brachytherapy alone.

In conclusion, findings from this important study should be helpfulwhen counseling patients regarding choice of initial therapy forlocalized prostate cancer. More importantly, however, this studyshould cause clinicians to reconsider the use of adjuvant hormoneablation therapy, as any potential survival advantage must beweighed against the negative impact these medications have onquality of life.

David F. PensonSection of UrologyUniversity of Washington School of MedicineSeattle, Washington

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