Skip to main content

Erectile function following brachytherapy, external beam radiotherapy, or radical prostatectomy in prostate cancer patients

Erektile Funktion nach Brachytherapie, externer Radiotherapie oder radikaler Prostatektomie bei Prostatakrebs-Patienten

Strahlentherapie und Onkologie volume 192, pages 182–189 (2016)Cite this article

Abstract

Background and purpose

For localized prostate cancer, treatment options include external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT). Erectile dysfunction (ED) is a common side-effect. Our aim was to evaluate penile erectile function (EF) before and after BT, EBRT, or RP using a validated self-administered quality-of-life survey from a prospective registry.

Material and methods

Analysis included 478 patients undergoing RP (n = 252), EBRT (n = 91), and BT (n = 135) with at least 1 year of follow-up and EF documented using IIEF-5 scores at baseline, 6 weeks, 6 months, 1 year, and annually thereafter.

Results

Differences among treatments were most pronounced among patients with no or mild initial ED (IIEF-5 ≥ 17). Overall, corrected for baseline EF and age, BT was associated with higher IIEF-5 scores than RP (+ 7.8 IIEF-5 score) or EBRT (+ 3.1 IIEF-5 score). EBRT was associated with better IIEF-5 scores than RP (+ 4.7 IIEF-5 score). In patients undergoing EBRT or RP with bilateral nerve sparing (NS), recovery of EF was observed and during follow-up, the differences to BT were not statistically significant. Overall age had a negative impact on EF preservation (corrected for baseline IIEF).

Conclusion

In our series, EF was adversely affected by each treatment modality. Considered overall, BT provided the best EF preservation in comparison to EBRT or RP.

Zusammenfassung

Hintergrund und Ziel

Die externe Radiotherapie (EBRT), die radikale Prostatektomie (RP) sowie die Brachytherapie (BT) stellen Behandlungsoptionen für das lokalisierte Prostatakarzinom dar. Die erektile Dysfunktion (ED) ist eine häufige Nebenwirkung dieser Therapien. Unser Ziel war es, die penile erektile Funktion (EF) vor und nach BT, EBRT und RP mit Hilfe eines validierten, vom Patienten ausgefüllten Lebensqualitätsfragebogens aus einer prospektiven Datenbank zu beurteilen.

Material und Methoden

Mit einer minimalen Nachbeobachtungszeit von einem Jahr wurden 478 Patienten analysiert, die eine RP (n = 252), EBRT (n = 91) oder BT (n = 135) erhalten hatten und deren EF mit dem IIEF-5-Score vor Therapie sowie nach 6 Wochen, 6 Monaten, nach einem Jahr und danach jährlich ermittelt worden sind.

Ergebnis

Die größten therapiebedingten Unterschiede wurden bei Patienten ohne oder nur mit milder initialer ED beobachtet (IIEF-5 ≥ 17). Korrigiert für die EF und das Alter bei Therapie, war die BT mit höherem IIEF-5-Score assoziiert als die RP (+ 7,8 IIEF-5-Score) oder die EBRT (+ 3,1 IIEF-5-Score). Die EBRT war mit einem besseren IIEF-5-Score assoziiert als die RP (+ 4,7 IIEF-5-Score). Bei Patienten mit bilateraler nervenschonender RP oder einer EBRT wurde eine Erholung der EF beobachtet; im Verlauf war der Unterschied zur BT nicht mehr statistisch signifikant. Insgesamt hatte ein höheres Alter einen negativen Einfluss auf die Erhaltung der EF (korrigiert für Ausgangs-EF).

Schlussfolgerung

In unserer Serie verschlechterte sich die EF durch alle Therapieformen. Insgesamt bot die BT die beste EF-Erhaltung verglichen mit der EBRT oder RP.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30

    Article  PubMed  Google Scholar 

  2. Wilt TJ, MacDonald R, Rutks I, Shamliyan TA, Taylor BC, Kane RL (2008) Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med 148:435–448

    Article  PubMed  Google Scholar 

  3. Eble MJ (2014) Bevölkerungsbasierte Analyse von Komplikationen nach lokaler Therapie des Prostatakarzinoms. Strahlenther Onkol 190:594–596

    Article  PubMed  Google Scholar 

  4. Penson DF, Feng Z, Kuniyuki A, McClerran D, Albertsen PC, Deapen D, Gilliland F, Hoffman R, Stephenson RA, Potosky AL, Stanford JL (2003) General quality of life 2 years following treatment for prostate cancer: what influences outcomes? Results from the prostate cancer outcomes study. J Clin Oncol 21:1147–1154

    Article  PubMed  Google Scholar 

  5. Valicenti RK, Bissonette EA, Chen C, Theodorescu D (2002) Longitudinal comparison of sexual function after 3-dimensional conformal radiation therapy or prostate brachytherapy. J Urol 168:2499–2504 (discussion 2504). doi:10.1097/01.ju.0000038153.45342.57

    Article  PubMed  Google Scholar 

  6. Wyler SF, Engeler DS, Seelentag W, Ries G, Schmid HP (2009) Health-related quality of life after radical prostatectomy and low-dose-rate brachytherapy for localized prostate cancer. Urol Int 82:17–23. doi:10.1159/000176019

    Article  PubMed  Google Scholar 

  7. Salomon L, Saint F, Anastasiadis AG, Sebe P, Chopin D, Abbou CC (2003) Combined reporting of cancer control and functional results of radical prostatectomy. Eur Urol 44:656–660

    Article  PubMed  Google Scholar 

  8. Resnick MJ, Koyama T, Fan KH, Albertsen PC, Goodman M, Hamilton AS, Hoffman RM, Potosky AL, Stanford JL, Stroup AM, Van Horn RL, Penson DF (2013) Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med 368:436–445. doi:10.1056/NEJMoa1209978

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  9. Moinpour CM, Hayden KA, Unger JM, Thompson IM Jr, Redman MW, Canby-Hagino ED, Higgins BA, Sullivan JW, Lemmon D, Breslin S, Crawford ED, Southwest Oncology G (2008) Health-related quality of life results in pathologic stage C prostate cancer from a Southwest Oncology Group trial comparing radical prostatectomy alone with radical prostatectomy plus radiation therapy. J Clin Oncol 26:112–120. doi:10.1200/JCO.2006.10.4505

    Article  PubMed  Google Scholar 

  10. Dolezel M, Odrazka K, Zouhar M, Vaculikova M, Sefrova J, Jansa J, Paluska P, Kohlova T, Vanasek J, Kovarik J (2015) Comparing morbidity and cancer control after 3D-conformal (70/74 Gy) and intensity modulated radiotherapy (78/82 Gy) for prostate cancer. Strahlenther Onkol 191:338–348

    Article  PubMed  Google Scholar 

  11. Carlsson S, Drevin L, Loeb S, Widmark A, Lissbrant IF, Robinson D, Johansson E, Stattin P, Fransson P (2015) Population-based study of long-term functional outcomes after prostate cancer treatment. BJU Int. doi:10.1111/bju.13179

  12. Boorjian SA, Eastham JA, Graefen M, Guillonneau B, Karnes RJ, Moul JW, Schaeffer EM, Stief C, Zorn KC (2012) A critical analysis of the long-term impact of radical prostatectomy on cancer control and function outcomes. Eur Urol 61:664–675. doi:10.1016/j.eururo.2011.11.053

    Article  PubMed  Google Scholar 

  13. Anandadas CN, Clarke NW, Davidson SE, O’Reilly PH, Logue JP, Gilmore L, Swindell R, Brough RJ, Wemyss-Holden GD, Lau MW, Javle PM, Ramani VA, Wylie JP, Collins GN, Brown S, Cowan RA, North West Uro-oncology G (2011) Early prostate cancer–which treatment do men prefer and why? BJU Int 107:1762–1768. doi:10.1111/j.1464-410X.2010.09833.x

    Article  PubMed  Google Scholar 

  14. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49:822–830

    Article  CAS  PubMed  Google Scholar 

  15. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM (1999) Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 11:319–326

    Article  CAS  PubMed  Google Scholar 

  16. Ramanathan R, Mulhall J, Rao S, Leung R, Martinez Salamanca JI, Mandhani A, Tewari A (2007) Predictive correlation between the International Index of Erectile Function (IIEF) and Sexual Health Inventory for Men (SHIM): implications for calculating a derived SHIM for clinical use. J Sex Med 4:1336–1344

    Article  PubMed  Google Scholar 

  17. Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6:65–70

    Google Scholar 

  18. R Core Team (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  19. Bates D Mächler M, Bolker B (2013) lme4: Linear mixed-effects models using S4 classes. R package version 0.999999-2

  20. Hothorn T, Bretz F, Westfall P (2008) Simultaneous inference in General Parametric Models. Biom J 50:346–336

    Article  PubMed  Google Scholar 

  21. van Tol-Geerdink JJ, Willem Leer J, Weijerman PC, van Oort IM, Vergunst H, van Lin EN, Alfred Witjes J, Stalmeier PF (2013) Choice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aid. BJU Int 111:564–573. doi:10.1111/j.1464-410X.2012.11402.x

    Article  PubMed  Google Scholar 

  22. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A, Klein E, Kibel A, Pisters LL, Kuban D, Kaplan I, Wood D, Ciezki J, Shah N, Wei JT (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358:1250–1261. doi:10.1056/NEJMoa074311

    Article  CAS  PubMed  Google Scholar 

  23. Magheli A, Burnett AL (2009) Erectile dysfunction following prostatectomy: prevention and treatment. Nat Rev Urol 6:415–427. doi:10.1038/nrurol.2009.126

    Article  PubMed  Google Scholar 

  24. Glickman L, Godoy G, Lepor H (2009) Changes in continence and erectile function between 2 and 4 years after radical prostatectomy. J Urol 181:731–735. doi:10.1016/j.juro.2008.10.019

    Article  PubMed  Google Scholar 

  25. Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, Gingrich JR, Wei JT, Gilhooly P, Grob BM, Nsouli I, Iyer P, Cartagena R, Snider G, Roehrborn C, Sharifi R, Blank W, Pandya P, Andriole GL, Culkin D, Wheeler T (2012) Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 367:203–213. doi:10.1056/NEJMoa1113162

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  26. Montorsi F, Brock G, Stolzenburg JU, Mulhall J, Moncada I, Patel HR, Chevallier D, Krajka K, Henneges C, Dickson R, Buttner H (2014) Effects of tadalafil treatment on erectile function recovery following bilateral nerve-sparing radical prostatectomy: a Randomised Placebo-controlled Study (REACTT). Eur Urol 65:587–596. doi:10.1016/j.eururo.2013.09.051

    Article  CAS  PubMed  Google Scholar 

  27. Turner SL, Adams K, Bull CA, Berry MP (1999) Sexual dysfunction after radical radiation therapy for prostate cancer: a prospective evaluation. Urology 54:124–129

    Article  CAS  PubMed  Google Scholar 

  28. Zelefsky MJ, Cowen D, Fuks Z, Shike M, Burman C, Jackson A, Venkatramen ES, Leibel SA (1999) Long term tolerance of high dose three-dimensional conformal radiotherapy in patients with localized prostate carcinoma. Cancer 85:2460–2468

    Article  CAS  PubMed  Google Scholar 

  29. van der Wielen GJ, Mulhall JP, Incrocci L (2007) Erectile dysfunction after radiotherapy for prostate cancer and radiation dose to the penile structures: a critical review. Radiother Oncol 84:107–113. doi:10.1016/j.radonc.2007.07.018

    Article  PubMed  Google Scholar 

  30. Potters L, Torre T, Fearn PA, Leibel SA, Kattan MW (2001) Potency after permanent prostate brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 50:1235–1242

    Article  CAS  PubMed  Google Scholar 

  31. Merrick GS, Butler WM, Wallner KE, Galbreath RW, Anderson RL, Kurko BS, Lief JH, Allen ZA (2005) Erectile function after prostate brachytherapy. Int J Radiat Oncol Biol Phys 62:437–447. doi:10.1016/j.ijrobp.2004.10.001

    Article  PubMed  Google Scholar 

  32. Stone NN, Stock RG (2007) Long-term urinary, sexual, and rectal morbidity in patients treated with iodine-125 prostate brachytherapy followed up for a minimum of 5 years. Urology 69:338–342. doi:10.1016/j.urology.2006.10.001

    Article  PubMed  Google Scholar 

  33. Ong WL, Hindson BR, Beaufort C, Pharoah P, Millar JL (2014) Long-term erectile function following permanent seed brachytherapy treatment for localized prostate cancer. Radiother Oncol 112:72–76. doi:10.1016/j.radonc.2014.04.017

    Article  PubMed  Google Scholar 

  34. Taira AV, Merrick GS, Galbreath RW, Butler WM, Wallner KE, Kurko BS, Anderson R, Lief JH (2009) Erectile function durability following permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 75:639–648. doi:10.1016/j.ijrobp.2008.11.058

    Article  PubMed  Google Scholar 

  35. Marina O, Warner J, Ye H, Grills IS, Shah C, Wallace M, Gustafson GS, Brabbins DS, Martinez AA, Krauss DJ (2014) An age-corrected matched-pair study of erectile function in patients treated with dose-escalated adaptive image-guided intensity-modulated radiation therapy vs. high-dose-rate brachytherapy for prostate cancer. Brachytherapy 13:163–168. doi:10.1016/j.brachy.2013.10.006

    Article  PubMed  Google Scholar 

  36. Litwin MS, Gore JL, Kwan L, Brandeis JM, Lee SP, Withers HR, Reiter RE (2007) Quality of life after surgery, external beam irradiation, or brachytherapy for early-stage prostate cancer. Cancer 109:2239–2247. doi:10.1002/cncr.22676

    Article  PubMed  Google Scholar 

  37. Pardo Y, Guedea F, Aguilo F, Fernandez P, Macias V, Marino A, Hervas A, Herruzo I, Ortiz MJ, Ponce de Leon J, Craven-Bratle J, Suarez JF, Boladeras A, Pont A, Ayala A, Sancho G, Martinez E, Alonso J, Ferrer M (2010) Quality-of-life impact of primary treatments for localized prostate cancer in patients without hormonal treatment. J Clin Oncol 28:4687–4696. doi:10.1200/JCO.2009.25.3245

    Article  PubMed  Google Scholar 

  38. Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB (2000) Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol 163:460–463

    Article  CAS  PubMed  Google Scholar 

  39. Nishimura S, Yorozu A, Ohashi T, Sakayori M, Yagi Y, Nishiyama T, Saito S, Shiraishi Y, Yoshida K, Toya K, Shigematsu N (2013) Five-year potency preservation after iodine-125 prostate brachytherapy. Int J Clin Oncol. doi:10.1007/s10147-013-0632-8

  40. Matsushima M, Kikuchi E, Maeda T, Nakashima J, Sugawara A, Ando T, Mizuno R, Nagata H, Miyajima A, Shigematsu N, Oya M (2013) A prospective longitudinal survey of erectile dysfunction in patients with localized prostate cancer treated with permanent prostate brachytherapy. J Urol 189:1014–1018. doi:10.1016/j.juro.2012.09.086

    Article  PubMed  Google Scholar 

  41. Alemozaffar M, Regan MM, Cooperberg MR, Wei JT, Michalski JM, Sandler HM, Hembroff L, Sadetsky N, Saigal CS, Litwin MS, Klein E, Kibel AS, Hamstra DA, Pisters LL, Kuban DA, Kaplan ID, Wood DP, Ciezki J, Dunn RL, Carroll PR, Sanda MG (2011) Prediction of erectile function following treatment for prostate cancer. JAMA 306:1205–1214. doi:10.1001/jama.2011.1333

    Article  CAS  PubMed  Google Scholar 

  42. Rizvi K, Hampson JP, Harvey JN (2002) Do lipid-lowering drugs cause erectile dysfunction? A systematic review. Fam Pract 19:95–98

    Article  PubMed  Google Scholar 

  43. Fonseca V, Seftel A, Denne J, Fredlund P (2004) Impact of diabetes mellitus on the severity of erectile dysfunction and response to treatment: analysis of data from tadalafil clinical trials. Diabetologia 47:1914–1923

    Article  CAS  PubMed  Google Scholar 

  44. McVary KT, Carrier S, Wessells H (2001) Smoking and erectile dysfunction: evidence based analysis. J Urol 166:1624–1632

    Article  CAS  PubMed  Google Scholar 

  45. Greenstein A, Chen J, Miller H, Matzkin H, Villa Y, Braf Z (1997) Does severity of ischemic coronary disease correlate with erectile function? Int J Impot Res 9:123–126

    Article  CAS  PubMed  Google Scholar 

  46. Magli A, Giangreco M, Crespi M, Negri A, Ceschia T, De Giorgi G, Titone F, Parisi G, Fongione S (2012) Erectile dysfunction after prostate three-dimensional conformal radiation therapy. Strahlenther Onkol 188:997–1002

    Article  CAS  PubMed  Google Scholar 

  47. Panje CM, Dal Pra A, Zilli T, D RZ, Papachristofilou A, Herrera FG, Matzinger O, Plasswilm L, Putora PM (2015) Consensus and differences in primary radiotherapy for localized and locally advanced prostate cancer in Switzerland: a survey on patterns of practice. Strahlenther Onkol. doi:10.1007/s00066-015-0849-8

  48. Pinkawa M, Piroth MD, Holy R, Djukic V, Klotz J, Krenkel B, Eble MJ (2011) Combination of dose escalation with technological advances (intensity-modulated and image-guided radiotherapy) is not associated with increased morbidity for patients with prostate cancer. Strahlenther Onkol 187:479–484. doi:10.1007/s00066-011-2249-z

    Article  PubMed  Google Scholar 

  49. van der Wielen GJ, van Putten WL, Incrocci L (2007) Sexual function after three-dimensional conformal radiotherapy for prostate cancer: results from a dose-escalation trial. Int J Radiat Oncol Biol Phys 68:479–484. doi:10.1016/j.ijrobp.2006.12.015

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    P. M. Putora, K. Buchauer & L. Plasswilm

  2. Department of Urology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    D. Engeler & H. P. Schmid

  3. Clinical Trials Unit, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    S. R. Haile & N. Graf

Authors
  1. P. M. Putora
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Engeler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. R. Haile
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Graf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Buchauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. P. Schmid
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. Plasswilm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Plasswilm.

Ethics declarations

Conflict of interest

P.M. Putora, D. Engeler, S.R. Haile, N. Graf, K. Buchauer, H.P. Schmid, and L. Passwilm state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form).

Additional information

P. M. Putora and D. Engeler contributed equally to the work.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Putora, P.M., Engeler, D., Haile, S.R. et al. Erectile function following brachytherapy, external beam radiotherapy, or radical prostatectomy in prostate cancer patients. Strahlenther Onkol 192, 182–189 (2016). https://doi.org/10.1007/s00066-015-0928-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-015-0928-x

Keywords

  • Quality of life
  • Erectile dysfunction
  • Brachytherapy
  • Prostatectomy
  • Radiotherapy

Schlüsselwörter

  • Lebensqualität
  • Erektile Dysfunktion
  • Brachytherapie
  • Prostatektomie
  • Radiotherapie