Abstract
After permanent prostate brachytherapy, erectile dysfunction is more common than initially reported. Using validated patient-administered instruments, approximately half of patients develop erectile dysfunction within 5 years of implantation. Preimplant erectile function and dose to the proximal penis appear to be the strongest predictors of brachytherapy-related impotence. Fortunately, the majority of patients respond to phosphodiesterase-5 inhibitors. Further elucidation of mechanisms of brachytherapyrelated erectile dysfunction may help to refine treatment techniques and improve potency preservation.
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Merrick GS, Wallner KE, Butler WM: Permanent interstitial brachytherapy for the management of carcinoma of the prostate gland. J Urol 2003, 169:1643–1652.
Merrick GS, Wallner KE, Butler WM, et al.: Minimizing prostate brachytherapy-related morbidity. Urology 2003, 62:786–792.
Crawford ED, Bennett CL, Stone NN, et al.: Comparison of perspectives on prostate cancer: analyses of survey data. Urology 1997, 50:366–372.
Stanford JL, Feng Z, Hamilton AS, et al.: Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the prostate cancer outcomes study. JAMA 2000, 283:354–360.
Penson DF, Feng Z, Kuniyuri A, et al.: General quality of life 2 years following treatment for prostate cancer: What influences outcomes? Results from the prostate cancer outcome study. J Clin Oncol 2003, 21:1147–1154.
NIH Consensus Conference: NIH Consensus Development Panel on Impotence: Impotence. JAMA 1993, 270:83–90.
Day D, Ambegaonkar A, Harriot K, et al.: A new tool for predicting erectile dysfunction. Adv Ther 2001, 18:131–139.
Burnett AL: Erectile dysfunction: a practical approach for primary care. Geriatrics 1998, 53:34–48.
Laumann EO, Paik A, Rosen RC: Sexual dysfunction in the United States: prevalence and predictions. JAMA 1999, 281:537–544.
Fossa FD, Woehre H, Kurth KH, et al.: Influence of urological morbidity on quality of life in patients with prostate cancer. Eur Urol 1997, 31(suppl 3):S3-S8.
Beard CJ, Propert KJ, Rieker PP, et al.: Complications after treatment with external-beam irradiation in early-stage prostate cancer patients: a prospective multiinstitutional outcomes study. J Clin Oncol 1997, 15:223–229.
Helgason AR, Adolfsson J, Dickman P, et al.: Factors associated with waning sexual function among elderly men and prostate cancer patients. J Urol 1997, 158:155–159.
Merrick GS, Wallner KE, Butler WM: Management of sexual dysfunction after prostate brachytherapy. Oncology 2003, 17:52–62.
Merrick GS, Butler WM, Wallner KE, et al.: Erectile function after prostate brachytherapy. In Int J Radiat Oncol Biol Phys 2005, In press. This prospective randomized study documented erectile function after brachytherapy using a validated patient-administered instrument (IIEF) and provided additional data substantiating the proximal penis as an important site-specific structure in the development of radiation-related ED.
Merrick GS, Wallner K, Butler WM, et al.: Short-term sexual function after prostate brachytherapy. Int J Cancer 2001, 96:313–319. This prospective randomized trial demonstrated that brachytherapyrelated sexual dysfunction consists not only of erectile deficiencies but also of additional short-term quality-of-life parameters, including hematospermia, orgasmalgia, and decreased orgasmic intensity.
Stock RG, Kao J, Stone NN: Penile erectile function after permanent radioactive seed implantation for treatment of prostate cancer. J Urol 2001, 165:436–439.
Merrick GS, Butler WM, Galbreath RW, et al.: Erectile function after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2002, 52:893–902.
Stone NN, Stock RG: Brachytherapy for prostate cancer: real time three-dimensional interactive seed implantation. Tech Urol 1995, 1:72–80.
Zelefsky MJ, Wallner KE, Ling CC, et al.: Comparison of the 5-year outcome and morbidity of three-dimensional conformal radiotherapy versus transperineal permanent iodine-125 implantation for early stage prostate cancer. J Clin Oncol 1999, 17:517–522.
Potters L, Torre T, Fearn PA, et al.: Potency after permanent prostate brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2001, 50:1235–1242.
Litwin MS, Lubeck DP, Henning JM, et al.: Differences in urologist and patient assessments of health related quality of life in men with prostate cancer: results of the CaPSURE database. J Urol 1998, 159:1988–1992.
Feldman HA, Goldstein I, Hatzichriftou DG, et al.: Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994, 151:54–61.
Zelefsky MJ, Wallner KE, Ling CC, et al.: Comparison of the 5-year outcome and morbidity of three-dimensional conformal radiotherapy versus transperineal permanent iodine-125 implantation for early stage prostate cancer. J Clin Oncol 1999, 17:517–522.
Stock RG, Kao J, Stone NN: Penile erectile function after permanent radioactive seed implantation for treatment of prostate cancer. J Urol 2001, 165:436–439.
Zelefsky MJ, Eid JF: Elucidating the etiology of erectile dysfunction after definitive therapy for prostate cancer. Int J Radiat Oncol Biol Phys 1998, 40:129–133.
Lepor H, Gregerman M, Crosby R, et al.: Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa: a detailed anatomical study of the adult male pelvis. J Urol 1985, 133:207–212.
DiBiase SJ, Wallner K, Tralins K, et al.: Brachytherapy radiation doses to the neurovascular bundles. Int J Radiat Oncol Biol Phys 2000, 46:1301–1307.
Merrick GS, Butler WM, Dorsey AT, et al.: A comparison of the radiation dose to the neurovascular bundles in men with and without prostate brachytherapy induced erectile dysfunction. Int J Radiat Oncol Biol Phys 2000, 46:1069–1074.
Kiteley RA, Lee WR, deGuzman AF, et al.: Radiation dose to the neurovascular bundles or penile bulb does not predict erectile dysfunction after prostate brachytherapy. Brachytherapy 2002, 1:90–94.
Wallner KE, Merrick GS, Benson ML, et al.: Penile bulb imaging. Int J Radiat Oncol Biol Phys 2002, 53:928–933.
Carrier S, Hricak H, Lee S, et al.: Radiation-induced decrease in nitric oxide synthase-containing nerves in the rat penis. Radiology 1995, 195:95–99.
Fisch BM, Pickett B, Weinberg V, et al.: Dose of radiation received by the bulb of the penis correlates with risk of impotence after three-dimensional conformal radiotherapy for prostate cancer. Urology 2001, 57:955–959. In a retrospective evaluation, these investigators reported a dose-volume relationship between radiation dose to the bulb of the penis and radiation-induced impotence and were the first to recommend the use of carefully designed radiation portals to limit the dose to the proximal penis.
Mulhall JP, Yonover P, Sethi A, et al.: Radiation exposure to the corporeal bodies during 3-dimensional conformal radiation therapy for prostate cancer. J Urol 2002, 167:539–542.
Selek U, Cheung R, Lii M, et al.: Erectile dysfunction and radiation dose to penile base structures: a lack of correlation. Int J Radiat Oncol Biol Phys 2004, 59:1039–1046.
Merrick GS, Wallner K, Butler WM, et al.: A comparison of radiation dose to the bulb of the penis in men with and without prostate brachytherapy induced erectile dysfunction. Int J Radiat Oncol Biol Phys 2001, 50:597–604.
Mulhall JP: Minimizing radiation-induced erectile dysfunction. J Brachyther Int 2001, 17:221–227.
Wallner K, Roy J, Harrison L: Tumor control and morbidity following transperineal iodine 125 implantation for stage T1/T2 prostatic carcinoma. J Clin Oncol 1996, 14:449–453.
Potters L, Torre T, Fearn PA, et al.: Potency after permanent prostate brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2001, 50:1235–1242.
Blander DS, Sanchez-Ortiz RF, Broderick GA: Sex inventories: Can questionnaires replace erectile dysfunction testing? Urology 1999, 54:719–723.
Rosen RC, Riley A, Wagner G, et al.: The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997, 49:822–830.
Karakiewicz PL, Aprikian AG, Bazinet M, et al.: Patient attitudes regarding treatment-related ED at the time of early detection of prostate cancer. Urology 1997, 50:704–709.
Schover LR, Fouladi RT, Warneke CL, et al.: Defining sexual outcomes after treatment for localized prostate carcinoma. Cancer 2002, 95:1773–1785.
Moreland RB: Is there a role of hypoxemia in penile fibrosis: a viewpoint presented to the Society for the Study of Impotence. Int J Impot Res 1998, 10:113–120.
Merrick GS, Butler WM, Lief JH, et al.: Efficacy of sildenafil citrate in prostate brachytherapy patients with erectile dysfunction. Urology 1999, 53:1112–1116.
Zelefsky MJ, McKee AB, Lee H, et al.: Efficacy of oral sildenafil in patients with erectile dysfunction after radiotherapy for carcinoma of the prostate. Urology 1999, 53:775–778.
Esposito K, Giugliano F, Di Palo C, et al.: Effect of lifestyle changes on erectile dysfunction in obese men. JAMA 2004, 291:2978–2984. This prospective randomized trial demonstrated that lifestyle changes, including weight loss, increased activity levels, and decreased caloric intake, can be associated with improvements in sexual function. Comparable approaches may prove helpful in the sexual rehabilitation of patients with prostate cancer.
Levine LA, McCullough AR, Padma-Nathan H: Longitudinal randomized placebo-controlled study of the return of nocturnal erections after nerve-sparing radical prostatectomy in men treated with nightly sildenafil citrate. J Urol 2004, 171:231–232.
Sommer F, Engelmann UH: What are the long term effects on erectile function of taking sildenafil on a daily basis? J Urol 2004, 171:239.
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Merrick, G.S., Butler, W.M. & Wallner, K.E. Brachytherapy-associated erectile dysfunction. Current Sexual Health Reports 2, 21–26 (2005). https://doi.org/10.1007/s11930-005-0018-7
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DOI: https://doi.org/10.1007/s11930-005-0018-7