Erectile function after three different types of treatment for localized prostate cancer


Another new paper has indicated that erectile function is better preserved among men treated by brachytherapy (radioactive seed implantation) than among men treated by radical prostatectomy or by external beam radiation therapy.

This new paper by Putora et al. (a Swiss research team) is based on prospectively collected quality of erectile function data, collected using the validated and patient self-administered IIEF-5 questionnaire prior to treatment (i.e., at baseline) and at 6 weeks, 6 months, 1 year, and annually thereafter  among a cohort of > 450 men treated for localized prostate cancer and followed for a minimum of 1 year after treatment.

Here is what Putora et al. report:

  • Total cohort size was 478 patients, of whom
    • 252/478 (52.7 percent) were treated by radical prostatectomy.
    • 91/478 (19.0 percent) were treated by external beam radiation therapy.
    • 135/478 (28.2 percent) were treated by brachytherapy.
  • Differences in post-treatment erectile function were most evident in patients who had relatively good erectile function (i.e., an IIEF score of 17 or higher) at baseline.
  • Patient age had a significant negative impact on recovery of erectile function post-treatment, regardless of treatment type (after correction for baseline IIEF score).
  • After correction for both age and baseline IEEF score
    • Men treated by brachytherapy had a higher IIEF score post treatment on average than
      • Men treated by external beam radiation (+ 3.1 IIEF score points)
      • Men treated by radical prostatectomy (+ 7.8 IEEF score points)
  • Significant recovery of erectile function over time was seen during follow-up for men treated by bilateral, nerve-sparing prostatectomy and by external beam radiation therapy.
  • Significant recovery of erectile function over time was not, however, observed among men treated by brachytherapy.

The authors conclude that, in their cohort of patients, erectile function was adversely affected to at least some degree by all three forms of treatment, but that, compared to external beam radiation therapy and radical prostatectomy, brachytherapy offered  a greater degree of preservation of baseline erectile function.

This is not exactly a new or surprising finding, since it confirms data previously published by others, most notably Sanda et al. back in 2008.

One Response

  1. Unfortunately, it did not include the two modalities that have reported the highest level of retained erectile function – HDR brachytherapy and SBRT.

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