There Is No Correlation Between Erectile Dysfunction and Dose to Penile Bulb and Neurovascular Bundles Following Real-Time Low-Dose-Rate Prostate Brachytherapy

Helical Tomotherapy vs. Intensity-Modulated Proton Therapy for Whole Pelvis Irradiation in High-Risk Prostate Cancer Patients: Dosimetric, Normal Tissue Complication Probability, and Generalized Equivalent Uniform Dose Analysis

“…The mean dose to the penile bulb was decreased to half in IMPT compared to HT, but again, the prediction of a clinical outcome caused by this sparing is difficult. Brachytherapy studies (25) have reported that radiation dose to the neurovascular bundles or penile bulb did not predict erectile dysfunction after prostate brachytherapy; the calculated mean maximum, mean minimum, and mean doses to 50% of the penile bulb did not differ between men who developed erectile dysfunction and those who did not. Also, in the external radiotherapy context, Brown et al (26) showed that the mean radiation dose to the penile bulb and volume of penile bulb treated were not associated with posttreatment potency.…”

Sexual Function After Stereotactic Body Radiotherapy for Prostate Cancer: Results of a Prospective Clinical Trial

“…Regarding PB dose and ED, there are roughly as many negative studies (28)(29)(30)(31)(32) as positive ones (33)(34)(35)(36)(37). A recent critical review of the published literature (38) concludes that there is insufficient evidence relating PB dose to ED.…”

Reproducibility in contouring the neurovascular bundle for prostate cancer radiation therapy

“…33 Moreover, a series of 147 patients undergoing prostate brachytherapy who had good potency before therapy found 3-year follow up rates of 23% of ED with 43% of patients using a potency aid. 19 The authors did not find any relationship between penile bulb dose or NVB dose and ED outcomes. The delineation of the NVB in this study was an area bounded by the posterolateral prostate, levator ani muscle, and the rectal wall.…”

“…4,11 External beam radiation therapy induced ED has an unclear cause, with the literature linking radiation dose to the bulb of the penis, the crura, and the NVB to ED, 3,12–16 with other series showing no dose effect to these structures causing ED. 17–19 The majority of these studies were done in an era before intensity modulated radiation therapy and, in series examining dose to the NVB, were limited to anatomical definitions based on a single cadaver 20 or examined dose to the NVB with brachytherapy alone. 17,21 As technology evolves and more conformal radiation techniques, including volumetric modulated arc therapy and dose-painting to single lobes of the prostate, are implemented, 22 the ability to limit dose to the NVB may be feasible for classically defined NVB in the posterolateral position relative to the prostate.…”