title: Erectile function following brachytherapy, external beam radiotherapy, or radical prostatectomy in prostate cancer patients.
abstract: OBJECTIVE
  For localized prostate cancer, treatment options include external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT). Erectile dysfunction (ED) is a common side-effect. Our aim was to evaluate penile erectile function (EF) before and after BT, EBRT, or RP using a validated self-administered quality-of-life survey from a prospective registry.
  
  
  METHODS
  Analysis included 478 patients undergoing RP (n = 252), EBRT (n = 91), and BT (n = 135) with at least 1 year of follow-up and EF documented using IIEF-5 scores at baseline, 6 weeks, 6 months, 1 year, and annually thereafter.
  
  
  RESULTS
  Differences among treatments were most pronounced among patients with no or mild initial ED (IIEF-5 ≥ 17). Overall, corrected for baseline EF and age, BT was associated with higher IIEF-5 scores than RP (+ 7.8 IIEF-5 score) or EBRT (+ 3.1 IIEF-5 score). EBRT was associated with better IIEF-5 scores than RP (+ 4.7 IIEF-5 score). In patients undergoing EBRT or RP with bilateral nerve sparing (NS), recovery of EF was observed and during follow-up, the differences to BT were not statistically significant. Overall age had a negative impact on EF preservation (corrected for baseline IIEF).
  
  
  CONCLUSIONS
  In our series, EF was adversely affected by each treatment modality. Considered overall, BT provided the best EF preservation in comparison to EBRT or RP.
authors.affiliation: Department of Radiation Oncology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: P M
authors.initials: PM
authors.lastname: Putora
authors.affiliation: Department of Urology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Engeler
authors.affiliation: Clinical Trials Unit, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: S R
authors.initials: SR
authors.lastname: Haile
authors.affiliation: Clinical Trials Unit, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Graf
authors.affiliation: Department of Radiation Oncology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Buchauer
authors.affiliation: Department of Urology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: H P
authors.initials: HP
authors.lastname: Schmid
authors.affiliation: Department of Radiation Oncology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland. ludwig.plasswilm@kssg.ch.
authors.forename: L
authors.initials: L
authors.lastname: Plasswilm
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D007172:Erectile Dysfunction / Q000453:epidemiology* / Q000517:prevention & control; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D011832:Radiation Injuries / Q000453:epidemiology; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Brachytherapy; Erectile dysfunction; Prostatectomy; Quality of life; Radiotherapy