Erectile function following brachytherapy, external beam radiotherapy, or radical prostatectomy in prostate cancer patients

Strahlenther Onkol. 2016 Mar;192(3):182-9. doi: 10.1007/s00066-015-0928-x. Epub 2015 Dec 28.


Background and purpose: For localized prostate cancer, treatment options include external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT). Erectile dysfunction (ED) is a common side-effect. Our aim was to evaluate penile erectile function (EF) before and after BT, EBRT, or RP using a validated self-administered quality-of-life survey from a prospective registry.

Material and methods: Analysis included 478 patients undergoing RP (n = 252), EBRT (n = 91), and BT (n = 135) with at least 1 year of follow-up and EF documented using IIEF-5 scores at baseline, 6 weeks, 6 months, 1 year, and annually thereafter.

Results: Differences among treatments were most pronounced among patients with no or mild initial ED (IIEF-5 ≥ 17). Overall, corrected for baseline EF and age, BT was associated with higher IIEF-5 scores than RP (+ 7.8 IIEF-5 score) or EBRT (+ 3.1 IIEF-5 score). EBRT was associated with better IIEF-5 scores than RP (+ 4.7 IIEF-5 score). In patients undergoing EBRT or RP with bilateral nerve sparing (NS), recovery of EF was observed and during follow-up, the differences to BT were not statistically significant. Overall age had a negative impact on EF preservation (corrected for baseline IIEF).

Conclusion: In our series, EF was adversely affected by each treatment modality. Considered overall, BT provided the best EF preservation in comparison to EBRT or RP.

Keywords: Brachytherapy; Erectile dysfunction; Prostatectomy; Quality of life; Radiotherapy.

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Brachytherapy / statistics & numerical data*
  • Causality
  • Comorbidity
  • Erectile Dysfunction / epidemiology*
  • Erectile Dysfunction / prevention & control
  • Germany / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Prostatectomy / statistics & numerical data*
  • Prostatic Neoplasms / epidemiology*
  • Prostatic Neoplasms / therapy*
  • Radiation Injuries / epidemiology
  • Radiotherapy, Conformal / statistics & numerical data*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome