Erectile dysfunction associated with prostate cancer treatment and therapeutic advances: a narrative review

Abstract

Background and objective: The treatment of prostate cancer (PCa) often comes with the risk of erectile dysfunction (ED). As therapeutic technologies continue to advance, the incidence of ED and its treatment methods are also evolving. This paper aimed to provide a comprehensive analysis of the latest developments in PCa treatment, with a particular focus on its relationship with ED, and to review current innovative strategies for ED treatment.

Methods: This study conducted a literature search in databases including PubMed, Excerpta Medica, Web of Science, Scopus, and the Cochrane Library, using keywords including "prostate cancer", "active surveillance", "radiation therapy", "cryotherapy", "radical prostatectomy", "immunotherapy", "chemotherapy", "androgen deprivation therapy", "erectile dysfunction", and "therapeutic advances", to collect English-language literature published from 1966 to June 2024.

Key content and findings: Active surveillance (AS) strategies have significantly reduced the incidence of ED. Technological advancements such as radiation therapy (RT), precise delineation techniques, and improvements in cryotherapy equipment are all dedicated to reducing the risk of ED. Intraoperative nerve monitoring combined with robot-assisted radical prostatectomy (RP) plays a key role in protecting the cavernous nerves and improving postoperative erectile function (EF) recovery. The impact of immunotherapy and chemotherapy on the risk of ED still needs to be clarified with additional clinical data. Androgen deprivation therapy (ADT) is often carried out as part of a combined treatment or through novel administration modalities to reduce its side effects. Given the limitations of traditional ED treatment methods, emerging treatments such as physical energy therapy, stem cell and platelet-rich plasma (PRP) therapy, gene and targeted therapies, tissue engineering and nerve transplantation, and traditional Chinese medicine (TCM) represent novel solutions for ED treatment.

Conclusions: With the innovation of PCa treatment technologies, the incidence of ED has declined, and emerging ED treatment methods have benefited the recovery of sexual function in patients with PCa. These advances may form the basis from which further innovations in PCa treatment strategies can be developed.

Keywords: Prostate cancer treatment (PCa treatment); erectile dysfunction (ED); therapeutic advances.

Figure 1

Causes of erectile dysfunction after radical prostatectomy. RP, radical prostatectomy; CC, corpus cavernosum; CCSMC, corpus cavernosum smooth muscle cell; ROS, reactive oxygen species; ED, erectile dysfunction.