Incidence of erectile dysfunction after EBT
for prostate cancer
In the 1980s, linear accelerators were routinely used to deliver megavolt energies, and
interstitial techniques were introduced. Comorbidity was seldom reported, with a few
exceptions, ED rates ranged from 11 to 73%. In the 1990's Postradiation ED rates varied
from 17 to 84% and, with regard to 3D-CRT, from 27 to 49%.
Prospective studies in the 1990's Although these prospective studies were conducted
adequately, rates of ED still varied considerably, from 7 to 72% .
Incidence
of erectile dysfunction after brachytherapy for prostate cancer
In studies from the 1970s rates of ED ranged from 0 to 25%, being
highest when BT was used in combination with EBT. In the 1990s, advances in radioisotope
development (with the introduction of Pd-103), the emergence of sophisticated 3D
computer-assisted dosimetry, intraoperative transrectal ultrasound (TRUS) availability,
and introduction of the transperineal approach produced a more homogeneous and
reproducible implant than had previously been possible. In general, in studies using
I-125, Pd-103 or both, the ED rates ranged from 2 to 51% with the
highest percentages again found when BT and EBT were combined . The highest ED rates,
ranging from 25 to 89%, have been reported in studies combining a temporary Ir-192 implant
with subsequent ERT. With respect to the differences between I-125 and Pd-103 BT, ED rates
were 6–21% and 15% , respectively.
Some studies reported the exact time of impotence evaluation after the
administration of I-125 or Pd-103 without ERT; ED rates were 2–8% at 12 months,
6–21% at 24 months, and 19% at 36 months.
The ability to achieve and sustain erections is only one component of sexuality. Loss of
libido and ejaculation disorders are very important as well. A deterioration of sexual
activity has been associated with the severity of ejaculatory dysfunction, particularly a
decrease in volume or an absence of semen . Ejaculatory
disturbances in BT studies varied from a reduction or absence of ejaculate volume
(7–45%) to discomfort during ejaculation (3–11%) and hemospermia (5%)
After EBT, a lack of ejaculation was reported in 2 to 56% of patients
Dissatisfaction with sex life was reported in 25–60% decreased
libido in 8–53% and decreased sexual desire in 12–58% One study reported a decreased intensity of orgasm, decreased
frequency and rigidity of erections, and decreased importance of sex
Comparisons between EBT and radical prostatectomy
Because of the growing popularity of 3D-CRT techniques in the 1990s, complications of ERT
and RP were compared.In comparative studies, ED rates after RP varied from 48 to 98%,
whereas after ERT these rates were 31–85%. A meta-analysis involving only men
potent before treatment showed that the probability of maintaining normal erections was
0.69 after ERT and 0.42 after RP. Potosky reported on a large cohort of 1591
patients with localized PC who received RP or ERT. After 2 years of treatment, men
receiving RP were more likely than men receiving ERT to be impotent (80% vs. 61%, p
< 0.001). In some recently published series on ED after RP, rates of ED varied from 60
to 68% at 18 months after treatment |
