Erectile dysfunction after novel nonsurgical treatments of prostate cancer

Erectile dysfunction (ED) is a well recognized adverse event following primary treatment of prostate cancer (PCa). Studies have shown that ED is one of the primary determinants of satisfaction after PCa treatment (surgical/non-surgical), and it is commonly associated with significant mental and physical distress, which in turn impairs quality of life. It is also one of the most feared and devastating treatment-related complications from a patient’s perspective, although not amongst the most catastrophic from an oncological urologist’s perspective. Most patients with clinically localized prostate cancer have a favorable long-term overall and cancer-specific survival rate irrespective of the treatment modality selected. Therefore, improvements in cancer control have been the target of medical and surgical oncological research as well as surgical industry. These improvements, however, have been accompanied by a heavier burden of treatment for prostate cancer survivors. Various less invasive nonsurgical treatment options, such as brachytherapy, intensity-modulated radiation therapy (IMRT), proton therapy, cryotherapy, different forms of focal therapy (high intensity focused ultrasound/HIFU, photodynamic therapy, radiofrequency ablation, stereotactic body radiotherapy or Cyber-knife, irreversible electroporation ablation or Nanoknife, and low temperature plasma/LTP), have been developed or are in various stages of evolution, evaluation and diffusion into clinical practice (Table). Some of these options are already currently availbale and accepted worldwide, either for the management of localized prostate cancer and/or as salvage procedures in well selected cases, where primary treatments have failed. However, although these novel treatment options are appealing to most patients and their physicians due an apparently lesser risk of side effects, they confer different patterns of toxicity compared with standard invasive, radical treatments. At present, the current literatrure is scarce, particularly in terms of prospective clinical trials that carefully document safety and functional outcomes. Recognition of the potential adverse consequences of these novel treatment options are critical to decrease suffering from otherwise non-lethal localized prostate cancer, and should encourage further investigation.