Erectile dysfunction represents a major side effect of prostate cancer (PCa) treatment, negatively impacting men's quality of life. While radiation therapy (RT) advances have enabled the mitigation of both genitourinary and gastrointestinal toxicities, no significant improvement has been showed in sexual quality of life over time.
The primary aim of this review was to assess sexual structures' dose-volume parameters associated with the onset of erectile dysfunction.
We searched the PubMed database and ClinicalTrials.gov until January 4, 2023. Studies reporting the impact of the dose delivered to sexual structures on sexual function or the feasibility of innovative sexual structure-sparing approaches were deemed eligible.
Sexual-sparing strategies have involved four sexual organs. The mean penile bulb doses exceeding 20 Gy are predictive of erectile dysfunction in modern PCa RT trial. Maintaining a D100% of ≤36 Gy on the internal pudendal arteries showed preservation of erectile function in 88% of patients at 5 yr. Neurovascular bundle sparing appears feasible with magnetic resonance-guided radiation therapy, yet its clinical impact remains unanswered. Doses delivered to the testicles during PCa RT usually remain <2 Gy and generate a decrease in testosterone levels ranging from -4.6% to -17%, unlikely to have any clinical impact.
Current data highlight the technical feasibility of sexual sparing for PCa RT. The proportion of erectile dysfunction attributable to the dose delivered to sexual structures is still largely unknown. While the ability to maintain sexual function over time is impacted by factors such as age or comorbidities, only selected patients are likely to benefit from sexual-sparing RT.
Technical advances in radiation therapy (RT) made it possible to significantly lower the dose delivered to sexual structures. While sexual function is known to decline with age, the preservation of sexual structures for prostate cancer RT is likely to be beneficial only in selected patients.
European urology oncology. 2023 Aug 26 [Epub ahead of print]
Jennifer Le Guevelou, Paul Sargos, Ludovic Ferretti, Stephane Supiot, David Pasquier, Gilles Créhange, Pierre Blanchard, Christophe Hennequin, Olivier Chapet, Ulrike Schick, Manon Baty, Ingrid Masson, Guillaume Ploussard, Renaud De Crevoisier, Igor Latorzeff
Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France. Electronic address: ., Department of Radiation Oncology, Institut Bergonié, Bordeaux, France., Department of Urology, MSP Bordeaux Bagatelle, Talence, France., Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, France., Department of Radiation Oncology, Centre Oscar Lambret, Lille, France., CNRS, CRIStAL UMR 9189, Université de Lille & Centrale Lille, Lille, France., Department of Radiation Oncology, Gustave Roussy, Cancer Campus, INSERM U1018 Oncostat, Université Paris-Saclay, Villejuif, France., Department of Radiation Oncology, Hôpital Saint-Louis, Paris, France., Department of Radiation Oncology, Hôpital Lyon Sud, Lyon, France., Department of Radiation Oncology, CHU de Brest, France., Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France., Department of Urology, Clinique La Croix-du-Sud, Quint-Fonsegrives, France; Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France., Department of Radiation Oncology, Clinique Pasteur, Toulouse, France.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37640583