Abstract
Studies assessing the relationship between dose to the penile bulb (PB) and risk of ED in men treated for prostate cancer with external beam radiation therapy (EBRT) have been critically scored. A review of published literature examining dose received by the PB and clinical erectile function outcomes for patients receiving EBRT was performed. Of 146 retrieved articles, 8 evaluated EBRT-induced ED in relation to PB dose. Half of these articles showed a relationship between dose to PB and ED, and the other half did not. A reliability score (RS) was constructed to more uniformly evaluate strengths and weaknesses of these eight articles. Subsequently, they were scored by two independent reviewers. An average of both scores was calculated. A close consensus was found (identical RS for six of the eight studies; kappa statistic: P=0.97). The studies with highest RS consistently support a relationship between ED and PB doses, whereas those with low scores did not. The RS-based analysis supports the recommended dose–volume limits specified in the Quantitative Analysis of Normal Tissue Effects in the Clinic review, maintaining the mean dose to 95% of the PB <50 Gy, although the target organ at risk is not likely to be the PB.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 8 print issues and online access
$259.00 per year
only $32.38 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C et al. Cancer statistics, 2006. CA Cancer J Clin 2006; 56: 106–130.
Robinson JW, Mortiz S, Fung T . Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma. Int J Radiat Oncol Biol Phys 2002; 54: 1063–1068.
Alemozaffar M, Regan M, Cooperberg M, Wei J, Michalski J, Sandler H et al. Prediction of erectile function following treatment for prostate cancer. JAMA 2011; 306: 1205–1214.
Burnett AL . Nitric oxide in the penis: physiology and pathology. J Urol 1997; 157: 320–324.
Dean RC, Lue TF . Physiology of penile erection and patho-physiology of erectile dysfunction. Urol Clin North Am 2005; 32: 379–395.
Roach M, Nam J, Gagliardi G, El Naga I, Deasy JO, Marks LB . Radiation dose-volume effects and the penile bulb. Int J Radiat Oncol Biol Phys 2010; 76: S130–S134.
Carrier S, Hriak H, Lee SS, Baba K, Morgan DM, Nunes L et al. Radiation-induced decrease in nitric oxide synthase-containing nerves in the rat penis. Radiology 1995; 195: 95–99.
Kimura M, Yan H, Rabbani Z, Satoh T, Baba S, Fang-fang Y et al. Radiation-induced erectile dysfunction using prostate-confined modern radiotherapy in a rat model. J Sex Med 2011; 8: 2215–2226.
Roach M, Alexander M . The prognostic significance of race and survival from breast cancer: a model for assessing the reliability of reported survival differences. J Natl Med Assoc 1995; 87: 214–219.
Bach P, Schrag D, Brawley O, Galaznik A, Yakren S, Begg C . Survival of Blacks and Whites After a Cancer Diagnosis. JAMA 2002; 287: 2106–2113.
Schroeck R, Donatucci C, Smathers E, Sun L, Albala DM, Polascik TJ et al. Defining potency: a comparison of the International Index of Erectile Function Short Version and the Expanded Cancer Index Composite. Cancer 2008; 113: 2667–2694.
Rosen R, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A . The international index of erectile function (IIEF): a multifunctional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830.
Cappeleri J, Bushmakin MS, Symonds T, Schnetzler G . Scoring correspondence in outcomes related to erectile dysfunction treatment on a 4-point scale (SCORE-4). J Sex Med 2009; 6: 809–819.
Fisch BM, Picket B, Weinberg V, Roach M . Dose of radiation received by the bulb of the penis correlates with a risk of impotence after three-dimensional conformal radiotherapy for prostate cancer. Urology 2001; 57: 955–959.
Roach M, Winter K, Michalski JM, Cox JD, Purdy JA, Bosch W et al. 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 2004; 60: 1351–1356.
Wernicke AG, Valincenti R, Dieva K, Houser C, Pequignot E . Radiation dose delivered to the proximal penis as a predictor of the risk of erectile dysfunction after three-dimensional conformal radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2004; 60: 1357–1363.
Mangar SA, Sydes MR, Tucker HL, Coffey J, Sohaib SA, Gianolini S et al. Evaluating the relationship between erectile dysfunction and dose received by the penile bulb: using data from a randomized controlled trial of conformal radiotherapy in prostate cancer. Radiother Oncol 2006; 80: 355–362.
Selek U, Cheung R, Lii M, Allen P, Steadham RE, Vantreese TR et al. Erectile dysfunction and radiation dose to the penile base structures: a lack of correlation. Int J Radiat Oncol Biol Phys 2004; 59: 1039–1046.
Brown MW, Brooks JP, Albert PS, Poggi MM . An analysis of erectile function after intensity modulated radiation therapy for localized prostate carcinoma. Prostate Cancer Prostatic Dis 2007; 10: 189–193.
van der Wielen GJ, Hoogeman MS, Dohle GR, van Putten WL, Incrocci L . Dose-volume parameters of the corpora cavernosa do not correlate with erectile dysfunction after external beam radiotherapy for prostate cancer: results from a dose-escalation trial. Int J Radiat Oncol Biol Phys 2008; 71: 795–800.
Wiegner E, King C . Sexual function after stereotactic body radiotherapy for prostate cancer: results of a prospective clinical trial. Int J Radiat Oncol Biol Phys 2010; 78: 442–448.
Mendenhall WM, Henderson RH, Indelicato DJ, Keole SR, Mendenhall NP . Erectile dysfunction after radiotherapy for prostate cancer. Am J Clin Onc 2009; 32: 443–447.
van der Wielen GJ, Mulhall JP, Incrocci L . Erectile dysfunction after radiotherapy for prostate cancer and radiation dose to the penile structures: a critical review. Radiother Oncol 2007; 84: 107–113.
Hoppe BS, Nichols RC, Henderson RH, Morris CG, Williams CR, Costa J et al. Erectile function, incontinence, and other quality of life outcomes following proton therapy for prostate cancer in men 60 years old and younger. Cancer 2012; 118: 4619–4626.
Magli A, Giangreco M, Crespi M, Negri A, Ceschia T, De Giorgi G et al. Erectile dysfunction after prostate three-dimensional conformal radiation therapy – correlation with the dose to the penile bulb. Strahlenther Onkol 2012; 188: 997–1002.
Perna L, Fiorino C, Cozzarini C, Broggi S, Cattaneo GM, De Cobelli F et al. Sparing the penile bulb in the radical irradiation of clinically localised prostate carcinoma: a comparison between MRI and CT prostatic apex definition in 3DCRT, Linac-IMRT and Helical Tomotherapy. Radiother Oncol 2009; 93: 57–63.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Rivin del Campo, E., Thomas, K., Weinberg, V. et al. Erectile dysfunction after radiotherapy for prostate cancer: a model assesing the conflicting literature on dose–volume effects. Int J Impot Res 25, 161–165 (2013). https://doi.org/10.1038/ijir.2013.28
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ijir.2013.28
Keywords
This article is cited by
-
Male sexual dysfunction and rehabilitation strategies in the settings of salvage prostate cancer treatment
International Journal of Impotence Research (2021)
-
Baseline status and dose to the penile bulb predict impotence 1 year after radiotherapy for prostate cancer
Strahlentherapie und Onkologie (2016)