Seksuele disfuncties na radiotherapie voor het prostaatcarcinoom

Prostate cancer has become the most frequent malignancy in men in The Netherlands. Radiation therapy is together with the radical prostatectomy the most effective treatment for localized disease. Even with the modern radiation techniques such as the three-dimensional conformal external-beam radiotherapy, erectile dysfunction can occur in up to 70% of the patients. In brachytherapy with radioactive seeds these percentages are normally lower, between 2 and 51%; in combination with external-beam radiotherapy erectile dysfunction is reported in between 25 and 89%. Decrease in libido and ejaculation problems are also commonly reported after radiation for prostate cancer, in up to 50% of the treated patients. A correct method of evaluating erectile function is the use of a validate questionnaire regarding different aspects of sexuality. This questionnaire has to be filled out before and 18-24 months after treatment. The etiology of erectile dysfunction after radiation for prostate cancer is more likely vascular. The neuro-vascular bundles always lie in the high radiation fields, although one study could not find a correlation between the radiation dose and erectile functioning. Other authors suggest a role of the penile bulbus that is partly irradiated. Also a history of cardiovascular disease, diabetes, pelvic operations, and the use of drugs can be important. Psychogenic factors such as fear of death are equally reported. Sildenafil (Viagra®) is effective in the treatment of erectile dysfunction following radiotherapy of prostate cancer; intracavernosal injections are also a good treatment option.