Erectile Dysfunction After External Beam Radiotherapy For Prostate Cancer
Currently, the most common curative treatment options for men with localized prostate cancer are radical prostatectomy, external beam radiotherapy and interstitial permanent brachytherapy and radical prostatectomy. Treatment decisions should particularly consider the specific risk and toxicity profile of a treatment method.
There is a lack of prospective studies focusing on the sexual quality of life of prostate cancer patients before and after a definitive conformal radiotherapy from the patients’ perspective. The aim of this study was to assess prospectively the incidence of erectile and predictive factors in a patient population treated with the same radiotherapy technique and a homogenous dose level, without antiandrogen treatment before radiotherapy or in the follow-up period. Patient age, comorbidities, prostate volume, planning target volume, pre-treatment sexual function and treatment of erectile dysfunction have been considered.
As with other studies, this study supports a progressively decreasing sexual function with longer follow-up intervals due to chronic radiotherapy effects, patient age and comorbidities. A stable level cannot be expected in a population of men with prostate cancer. However, chronic erectile dysfunction can very well be predicted shortly after radiotherapy, so that erectile dysfunction cannot only be regarded as a chronic effect of irradiation. As common after radical prostatectomy, the initiation of an early treatment could result in improved erectile function after radical radiotherapy.
Patient age and sexual function are the most important prognostic factors for the return of potency after radical prostatectomy. As shown in our study, these factors are equally of major importance after radiotherapy. The best predictor for preserving erections sufficient for sexual intercourse is the occurrence of spontaneous erections in the morning or night, before treatment. Diabetic patients are not only predisposed for erectile dysfunction before radiotherapy, but additionally for post- radiotherapy acquired erectile dysfunction.
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