Erectile Dysfunction after External Beam Radiotherapy for Prostate Cancer: can it be prevented?

Around 8000 men are diagnosed with prostate cancer in the Netherlands every year (1). With the exception of skin cancer, it is the most common type of cancer in men. There are several ways to treat prostate cancer: hormonal therapy, radical prostatectomy, brachytherapy and external beam radiotherapy or a combination of these. A large part of the patients is treated with external beam radiotherapy. Three-dimensional conformal radiotherapy has been the standard technique for more than a decade. In three-dimensional conformal radiotherapy a computed tomography (CT) scan, called a planning CT scan, is performed in order to image the prostate and the surrounding organs. The physician delineates the prostate and anatomical structures that may cause radiation-induced toxicity, the organs at risk. Using this planning CT scan a treatment plan is made with the goal to distribute a high radiation dose in the prostate and a minimal dose in organs at risk, like the rectum. To achieve this goal radiation beams incident from various directions are created conform to the contour of prostate, avoiding the organs at risk. However, there are several uncertainties regarding delineation of the planning CT scan, deformation and movement of the prostate and patient (2). Therefore a margin of commonly 1 cm around the prostate is added to account for these uncertainties. The actual radiotherapy treatment is then delivered during 7 or 8 weeks in up to 39 fractions of 2 Gray (Gy) in our institute. All forms of treatment for prostate cancer, radiotherapy, prostatectomy and hormonal therapy, have an impact on sexual functioning and especially on erectile function (3-5). Because there is no clear evidence showing a survival benefit for one treatment above another (6), differences in quality of life after treatment, including sexual function, might influence the choice of treatment. A patient must be informed about the consequences of different treatments to enable the patient to make a rational choice.

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