Sexual (dys)function after radiotherapy for prostate cancer: a review.
ABSTRACT Prostate cancer has become the most common nonskin malignant neoplasm in older men in Western countries. As treatment efficacy has improved, issues related to posttherapy quality of life and sexual functioning have become more important.
We discuss the various methods used to evaluate erectile and sexual dysfunction and the definition of potency. The etiologies of erectile dysfunction after external beam radiotherapy and brachytherapy for prostate cancer are also reviewed. The literature is summarized, and comparative studies of radiation and surgery are surveyed briefly.
Rates of erectile dysfunction vary from 6 to 84% after external beam radiotherapy and from 0 to 51% after brachytherapy. In most of the studies, the analysis is retrospective, the definition of erectile dysfunction is not clear, only one question about sexual functioning is asked, and nonvalidated instruments are used. The etiology of erectile dysfunction after radiation for prostate cancer is not completely understood.
Because erectile function is only one component of sexual function, it is necessary to assess sexual desire, satisfaction, frequency of intercourse, and other such factors when evaluating the effects of therapy. Patients should be offered sexual counseling and informed about the availability of effective treatments for erectile dysfunction, such as sildenafil, intracavernosal injection, and vacuum devices.
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ABSTRACT: The number of patients diagnosed with early stage prostate cancer (PC) has increased dramatically, because of routine prostate-specific antigen testing in the recent years and the possibility for cure of early disease. Radiation therapy is together with radical prostatectomy the most effective treatment for localized disease. Incidence of erectile dysfunction (ED) after radiotherapy (RT) reported in the literature vary from 6% to 84% after external-beam RT to 0–51% after brachytherapy. Most of these studies are retrospective, the definition of ED is variable and sexual functioning is frequently assessed by asking only one question. Already in the 1980s it was suggested that post-radiation ED was attributable to vascular damage. More recently, a strong relationship between radiation dose and volume of the penile bulb has been found. Though, a multifactorial etiology has to be considered taking into account pre-treatment erectile function. If radiation induces vascular damage that causes ED, any means of reducing the dose to the pelvic vascular structures would likely decrease ED. Patients need to be informed about the availability of effective treatments such as PDE5-I, intracavernosal injection and vacuum devices.Sexologies 04/2006; 15(2):116-120.
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ABSTRACT: Résumé: La radiothérapie conformationnelle, avec ou sans modulation d’intensité, fait partie intégrante du traitement du cancer de la prostate, au même titre que la chirurgie ou la curiethérapie. L’établissement des plans de traitement sur tomodensitométrie a permis de réaliser une escalade de dose tout en maintenant une toxicité acceptable. La littérature montre que la survie sans récidive biologique et sans métastases est corrélée à la dose délivrée. D’autres développements technologiques vont permettre d’accroître encore l’index thérapeutique de cette technique.Oncologie 10/2004; 6(6):416-421. · 0.08 Impact Factor
- Journal of Sexual Medicine 11/2004; 1:6-7. · 3.15 Impact Factor