title: The dosimetry of brachytherapy-induced erectile dysfunction.
abstract: There is emerging evidence that brachytherapy-induced erectile dysfunction (ED) is technique-related and may be minimized by careful attention to source placement. Herein, we review the relationship between radiation doses to the prostate gland/surrounding structures and the development of brachytherapy-induced ED. The permanent prostate brachytherapy literature was reviewed using MEDLINE searches to ensure completeness. Although the site-specific structure associated with brachytherapy-induced ED remains unknown, there is an increasing body of data implicating the proximal penis. With day 0 CT-based dosimetry, the dose to 50% (D50) and 25% (D25) of the bulb of the penis should be maintained below 40% and 60% mPD, respectively, while the crura D50 should be maintained below 28% mPD to maximize post-brachytherapy potency. To date, there is no data to suggest that either radiation doses to the neurovascular bundles or choice of isotope is associated with brachytherapy-induced ED, while conflicting data has been reported regarding radiation dose to the prostate and the use of supplemental external beam radiation therapy. Although the etiology of brachytherapy-induced ED is likely multifactorial, the available data supports the proximal penis as an important site-specific structure. Refinements in implant technique, including preplanning and intraoperative seed placement, will result in lower radiation doses to the proximal penis with potential improvement in potency preservation.
authors.affiliation: Schiffler Cancer Center, Wheeling Hospital, 1 Medical Park, Wheeling, WV 26003-6300, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Merrick
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Butler
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D007172:Erectile Dysfunction / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D010413:Penis / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011829:Radiation Dosage; D011879:Radiotherapy Dosage