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Risk of erectile dysfunction after modern radiotherapy for intact prostate cancer

Prostate Cancer and Prostatic Diseases volume 24, pages 128–134 (2021)Cite this article

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Abstract

Background

Erectile dysfunction (ED) is a prevalent side effect of prostate cancer treatment. We hypothesized that the previously reported rates of ED may have improved with the advent of modern technology. The purpose of this project was to evaluate modern external beam radiotherapy and brachytherapy techniques to determine the incidence of radiotherapy (RT) induced ED.

Methods

A systematic review of the literature published between January 2002 and December 2018 was performed to obtain patient reported rates of ED after definitive external beam radiotherapy, ultrafractionated stereotactic radiotherapy, and brachytherapy (BT) to the prostate in men who were potent prior to RT. Univariate and multivariate analyses of radiation dose, treatment strategy, and length of follow-up were analyzed to ascertain their relationship with RT-induced ED.

Results

Of 890 articles reviewed, 24 met inclusion criteria, providing data from 2714 patients. Diminished erectile function status post RT was common and similar across all studies. The median increase in men reporting ED was 17%, 26%, 23%, and 23%, 3DCRT, IMRT, low dose rate BT, and SBRT, respectively, at 2-year median follow-up.

Conclusion

ED is a common side effect of RT. Risk of post-RT ED is similar for both LDR brachytherapy and external beam RT with advanced prostate targeting and penile-bulb sparing techniques utilized in modern RT techniques.

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Fig. 1: PRISMA diagram of systematic identification and review of articles.
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Acknowledgements

This work was funded by a grant from the Josiah Charles Trent Memorial Foundation Endowment Fund.

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Authors and Affiliations

  1. University of Colorado School of Medicine, Aurora, CO, USA

    Anastasia A. Hunt

  2. Department of Biostatistics and Bioinformatics, Duke School of Medicine, Durham, NC, USA

    Kingshuk Roy Choudhury

  3. Duke University, Durham, NC, USA

    Varun Nukala & Alina Ahmad

  4. Department of Clinical Sciences and Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA

    Michael W. Nolan

  5. Duke Cancer Institute, Durham, NC, USA

    Michael W. Nolan, Kathleen A. Ashcraft & Bridget F. Koontz

  6. Department of Radiation Oncology, Duke University, Durham, NC, USA

    Kathleen A. Ashcraft & Bridget F. Koontz

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Correspondence to Bridget F. Koontz.

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Hunt, A.A., Choudhury, K.R., Nukala, V. et al. Risk of erectile dysfunction after modern radiotherapy for intact prostate cancer. Prostate Cancer Prostatic Dis 24, 128–134 (2021). https://doi.org/10.1038/s41391-020-0247-x

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