Sexual dysfunction following low-dose-rate brachytherapy for prostate cancer

   Prostate cancer (PCa) is one of the most prevalent forms of male malignancies globally, ranking second in terms of incidence and sixth in terms of mortality. Low-dose-rate brachytherapy (LDRT) represents a treatment modality for PCa, involving the implantation of permanent radioactive sources into the prostate tissue. The isotopes predominantly utilised are I–125 and Pd–103. LDRT demonstrates high rates of biochemical and clinical relapse-free survival, with cancer-specific and overall survival rates comparable to those achieved through radical prostatectomy. Despite the advantages associated with LDRT, evidence has accumulated regarding the potential complications accompanying this treatment approach, including sexual dysfunction and erectile dysfunction. Sexual satisfaction constitutes a critical concern for men undergoing PCa treatment. It is essential that both the patient and the healthcare provider prioritise not only erectile function but also the preservation of sexuality in its entirety.

   The present study endeavours to evaluate the accumulated material on the topic of diagnosing and treating sexual dysfunctions following low-dose-rate brachytherapy (LDRT).

   The analysis encompassed articles by foreign and domestic authors published between 2014 and 2024, as well as fundamental articles and literature dating back earlier. These works were devoted to sexual dysfunction, assessment, and rehabilitation of sexual function in patients with PCa who underwent LDRT. Our review confirmed the existing necessity for a detailed study of rational methods for diagnosing sexual dysfunctions prior to selecting a treatment method, as well as the possible prevention of disorders after LDRT. It is also essential to develop sexual and penile rehabilitation strategies following LDRT for PCa, which is currently widely employed.

1. Somov AN, Suslin SA. Prostate cancer. Epidemiology, risk factors and early detection. Russian Journal of Preventive Medicine. 2020;23(3):149-155. (In Russian). DOI: 10.17116/profmed202023031149

2. EAU Guidelines on prostate cancer. Edn. presented at the EAU Annual Congress Paris 2024. ISBN 978-94-92671-23-3. (Accessed on September 15, 2024) URL: https://uroweb.org/guidelines/prostate-cancer

3. Raabe NK, Normann M, Lilleby W. Low-dose-rate brachytherapy for low-grade prostate cancer. Tidsskr Nor Laegeforen. 2015;135(6):548-552. (In English, Norwegian). DOI: 10.4045/tidsskr.13.1404

4. Merrick G., Butler W., Lief J., Dorsey A. Temporal resolution of urinary morbidity following prostate brachytherapy. Int J RadiatOncolBiolPhys 2000;47:121–128. DOI: 10.1016/s0360-3016(99)00525-8

5. Hennequin C, Cormier L, Richaud P, Bastide C, Beuzeboc P, Fromont G, Mongiat-Artus P, Peyromaure M, Ploussard G, Renard-Penna R, Rozet F, Soulié M, Salomon L; Les membres du CC-AFU. Curiethérapie exclusive du cancer de la prostate par implants permanents: indications et résultats. Revue du CC-AFU [Prostate brachytherapy: indications and outcomes]. Prog Urol. 2013;23(6):378-385. (In French). DOI: 10.1016/j.purol.2012.12.006

6. Colson MH, Lechevallier E, Rambeaud JJ, Alimi JC, Faix A, Gravis G, Hannoun-Levi JM, Quintens H, Rébillard X, Droupy S. Sexualité et cancer de la prostate [Sexuality and prostate cancer]. Prog Urol. 2012;22 Suppl 2:S72-92. (In French). DOI: 10.1016/S1166-7087(12)70039-8

7. Barros R, Favorito LA, Nahar B, Almeida R Jr, Ramasamy R. Changes in male sexuality after urologic cancer : a narrative review. Int Braz J Urol. 2023;49(2):175-183. DOI: 10.1590/S1677-5538.IBJU.2023.9901

8. Chebbi A. Dysfonctions sexuelles après traitement du cancer de la prostate [Sexual dysfunction after prostate cancer treatment]. Rev Prat. 2023;73(8):879-884. (In French). PMID: 38354013

9. Chung E, Gillman M. Prostate cancer survivorship : a review of erectile dysfunction and penile rehabilitation after prostate cancer therapy. Med J Aust. 2014;200(10):582-585. DOI: 10.5694/mja13.11028

10. Chung E. Male sexual dysfunction and rehabilitation strategies in the settings of salvage prostate cancer treatment. Int J Impot Res. 2021;33(4):457-463. DOI: 10.1038/s41443-021-00437-4

11. Greimel E, Nagele E, Lanceley A, Oberguggenberger AS, Nordin A, Kuljanic K, Arraras JI, Wei-Chu C, Jensen PT, Tomaszewski KA, Creutzberg CL, Galalae R, Toelen H, Zimmermann K, Bjelic-Radisic V, Costantini A, Almont T, Serpentini S, Paskeviciute Frøding L, Vistad I, Schmalz C; EORTC Quality of Life Group. Psychometric validation of the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire Sexual Health (EORTC QLQ-SH22). Eur J Cancer. 2021;154:235-245. DOI: 10.1016/j.ejca.2021.06.003

12. Schoentgen N, Marolleau J, Delage F, Coquet JB, Fourcade A, Callerot P, Serey-Eiffel S, Malhaire JP, Pradier O, Schick U, Fournier G, Valeri A. Prospective four years of evaluation of erectile function after low-dose-rate prostate brachytherapy using baseline IIEF-5 > 16. J Contemp Brachytherapy. 2019;11(3):195-200. DOI: 10.5114/jcb.2019.85793

13. O’Leary E, Drummond FJ, Gavin A, Kinnear H, Sharp L. Psychometric evaluation of the EORTC QLQ-PR25 questionnaire in assessing health-related quality of life in prostate cancer survivors: a curate’s egg. Qual Life Res. 2015;24(9):2219-2230. DOI: 10.1007/s11136-015-0958-y

14. Crump RT, Peterson A, Charbonneau C, Carlson KV, Sutherland JM, Baverstock RJ. Evaluating the measurement properties of the 26-item Expanded Prostate Cancer Index Composite (EPIC-26) with a multi-center cohort. Can Urol Assoc J. 2020;14(4):111-117. DOI: 10.5489/cuaj.5997

15. Kireev A.Yu. A new approach to the assessment male sexuality in symptomatic benign prostatic hyperplasia (Rostov questionnaire). Urology Herald. 2013;(2):30-37. (In Russian). DOI: 10.21886/2308-6424-2013-0-2-30-37

16. Zakhour S, Sardinha A, Levitan M, Berger W, Nardi AE. Instruments for assessing sexual dysfunction in Arabic : A systematic literature review. Transcult Psychiatry. 2022;59(6):819-830. DOI: 10.1177/13634615221105120

17. Peng LC, Mian OY, Lakshminarayanan P, Huang P, Bae HJ, Robertson S, Habtu T, Narang A, Agarwal S, Greco S, Tran P, McNutt T, DeWeese TL, Song DY. Analysis of Spatial Dose-Volume Relationships and Decline in Sexual Function Following Permanent Brachytherapy for Prostate Cancer. Urology. 2020;135:111-116. DOI: 10.1016/j.urology.2019.08.014

18. Kiteley RA, Lee WR, deGuzman AF, Mirzaei M, McCullough DL. Radiation dose to the neurovascular bundles or penile bulb does not predict erectile dysfunction after prostate brachytherapy. Brachytherapy. 2002;1(2):90-94. DOI: 10.1016/s1538-4721(02)00018-1

19. EAU Guidelines on sexual and reproductive health. Edn. presented at the EAU Annual Congress Paris April 2024. ISBN 978-94-92671-23-3. (Accessed on September 15, 2024) URL: https://uroweb.org/guidelines/sexual-and-reproductive-health

20. Viktorin-Baier P, Putora PM, Schmid HP, Plasswilm L, Schwab C, Thoeni A, Hochreiter W, Prikler L, Suter S, Stucki P, Müntener M, Blick N, Schiefer H, Güsewell S, Zürn K, Engeler D. Long-term oncological and functional follow-up in low-dose-rate brachytherapy for prostate cancer: results from the prospective nationwide Swiss registry. BJU Int. 2020;125(6):827-835. DOI: 10.1111/bju.15003

21. Zhang P, Qian B, Shi J, Xiao Y. Radical prostatectomy versus brachytherapy for clinically localized prostate cancer on oncological and functional outcomes: a meta-analysis. Transl Androl Urol. 2020;9(2):332-343. DOI: 10.21037/tau.2020.02.15

22. Pugh TJ, Mahmood U, Swanson DA, Munsell MF, Wang R, Kudchadker RJ, Bruno TL, Frank SJ. Sexual potency preservation and quality of life after prostate brachytherapy and low-dose tadalafil. Brachytherapy. 2015;14(2):160-165. DOI: 10.1016/j.brachy.2014.08.045

23. Pisansky TM, Pugh SL, Greenberg RE, Pervez N, Reed DR, Rosenthal SA, Mowat RB, Raben A, Buyyounouski MK, Kachnic LA, Bruner DW. Tadalafil for prevention of erectile dysfunction after radiotherapy for prostate cancer: the Radiation Therapy Oncology Group [0831] randomized clinical trial. JAMA. 2014;311(13):1300-7. DOI: 10.1001/jama.2014.2626

24. Prasad R, Wanjari M, Lamture YR, Late S, Sharma R. Penile rehabilitation effectiveness after prostate cancer treatment : A systematic review of randomized controlled trials. Narra J. 2023;3(2):e174. DOI: 10.52225/narra.v3i2.174

25. Green TP, Saavedra-Belaunde J, Wang R. Ejaculatory and Orgasmic Dysfunction Following Prostate Cancer Therapy: Clinical Management. Med Sci (Basel). 2019;7(12):109. DOI: 10.3390/medsci7120109

26. Huyghe E, Delannes M, Wagner F, Delaunay B, Nohra J, Thoulouzan M, Shut-Yee JY, Plante P, Soulie M, Thonneau P, Bachaud JM. Ejaculatory function after permanent 125I prostate brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2009;74(1):126-32. DOI: 10.1016/j.ijrobp.2008.07.064

27. Sullivan JF, Stember DS, Deveci S, Akin-Olugbade Y, Mulhall JP. Ejaculation profiles of men following radiation therapy for prostate cancer. J Sex Med. 2013;10(5):1410-1416. DOI: 10.1111/jsm.12101

28. Delavierre D, Sibert L, Rigaud J, Labat JJ. L’éjaculation douloureuse [Painful ejaculation]. Prog Urol. 2014;24(7):414-420. (In French). DOI: 10.1016/j.purol.2013.11.008

29. Nguyen DD, Berlin A, Matthew AG, Perlis N, Elterman DS. Sexual function and rehabilitation after radiation therapy for prostate cancer : a review. Int J Impot Res. 2021;33(4):410-417. DOI: 10.1038/s41443-020-00389-1

30. Wassersug RJ. Maintaining intimacy for prostate cancer patients on androgen deprivation therapy. Curr Opin Support Palliat Care. 2016;10(1):55-65. DOI: 10.1097/SPC.0000000000000190

31. Wang F, Luan Y, Fan Y, Huang T, Zhu L, Lu S, Tao H, Sheng T, Chen D, Ding X. Comparison of the Oncological and Functional Outcomes of Brachytherapy and Radical Prostatectomy for Localized Prostate Cancer. Medicina (Kaunas). 2022;58(10):1387. DOI: 10.3390/medicina58101387