Erectile dysfunction following radiotherapy and brachytherapy for prostate cancer: pathophysiology, prevention and treatment
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Although detrimental impact on sexual function following radiotherapy (RT) and brachytherapy decreases the quality of life of prostate cancer survivors, the etiology, pathophysiology, prophylaxis and treatment of this condition has not yet been fully clarified. We reviewed the published literature in terms of etiology, treatment and possible prevention of erectile dysfunction (ED) following RT and/or brachytherapy.
We have reviewed the literature through a MEDLINE search. Prostate cancer, erectile dysfunction, radiotherapy, brachytherapy, treatment and quality of life were used as keywords.
Both RT and brachytherapy result in high rates of ED. Although arterial damage seems to be the main cause of ED after RT, exposure of neurovascular bundle to high levels of radiation dose has been also implicated in some studies with brachytherapy. The radiation dose received by the corpora cavernosa at the crurae of the penis may also be important in the etiology of ED. The most important predictive factor of ED following RT is the treatment modality. Intensity-modulated radiotherapy and vessel-sparing prostate radiotherapy are new techniques but those treatments may not guarantee complete preservation of the erectile function. Patients need to be correctly informed on the possible sequela of radiation-based treatments on their sexual well-being while planning their treatment. Patients should also be informed about the possible treatment modalities for ED, which may develop in due course.
KeywordsBrachytherapy Erectile dysfunction Prostate carcinoma Radiotherapy Treatment
- 1.Sobin LH, Wittekind CH (1997) UICC TNM Classification of Malignant Tumors, 5th edn. New YorkGoogle Scholar
- 5.Stanford JL, Stephenson RA, Coyle LM. Prostate Cancer Trends 1973–1995. NIH Publication No. 99–4543. Bethesda, SEER Program, National Cancer Institute, 1999. Google Scholar
- 13.Roach M, Winter K, Michalski JM et al (2004) Penile bulb dose and impotence after three-dimensional conformal radiotherapy for prostate cancer on RTOG 9406: findings from a prospective, multi-institutional, phase I/II dose– escalation study. Int J Radiat Oncol Biol Phys 60:1351–1356PubMedCrossRefGoogle Scholar
- 23.Narayana V, Meirovitz A, Troyer S et al (2005) Vessel-sparing prostate radiotherapy: dose limitation to critical erectile vascular structures (internal pudendal artery and corpus cavernosum) defined by MRI. Int J Radiat Oncol Biol Phys 61:1–2Google Scholar
- 27.Tomic R (1983) Some effects of orchiectomy, oestrogen treatment and radiation therapy in patients with prostatic carcinoma. Scand J Urol Nephrol 7:1–37Google Scholar
- 46.Merrick GS, Wallner KE, Butler WM (2003) Management of sexual dysfunction after prostate brachytherapy. Oncology (Huntingt) 17:52–62(discussion 62, 67–70, 73)Google Scholar
- 66.Incrocci L, Slagter C, Slob AK et al (2006) A randomized, double-blind, placebo-controlled, cross-over study to assess the efficacy of Tadalafil (Cialis) in the treatment of erectile dysfunction following three-dimensional conformal external-beam radiotherapy for prostatic carcinoma. Int J Radiat Oncol Biol Phys 66:439–444PubMedGoogle Scholar