Radiation-induced erectile dysfunction in prostate cancer: A systematic review of pathophysiology, clinical radiobiology, and predictive modeling
Abstract
Background: Radiation-induced erectile dysfunction (RIED) remains one of the most prevalent and distressing late toxicities among prostate cancer survivors. Despite advances in radiation therapy techniques, its underlying mechanisms, dose-response relationships, and predictive modeling strategies are not yet fully understood.
Methods: We searched PubMed/MEDLINE, Web of Science, Scopus, Embase and Cochrane Library from inception to November 10, 2025. Eligible English-language studies included adult prostate cancer patients treated with radiotherapy and reported evidence on erectile outcomes, pathophysiology, radiobiology, dose-response relationships or predictive modeling. Data were extracted using a standardized form, quality was assessed with the Newcastle-Ottawa Scale, and findings were synthesized narratively according to PRISMA 2020.
Results: Thirty-nine peer-reviewed studies were included in the primary synthesis. RIED was associated with interacting neurovascular, smooth-muscle and endocrine mechanisms. Age, baseline erectile function, comorbidities, androgen deprivation therapy and radiation dose to erectile-relevant structures were key determinants of risk. Dose-response findings, particularly for the penile bulb, were inconsistent across studies because of heterogeneous contouring, endpoints, treatment techniques and confounder adjustment. No externally validated RIED-specific NTCP model was identified. Machine-learning, deep-learning and radiogenomic approaches…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Preliminary Toxicity Analysis of 3DCRT versus IMRT on the High Dose Arm of the RTOG 0126 Prostate Cancer Trial
- Adaptive Radiotherapy for Head and Neck Cancer: Initial Clinical Outcomes from a Prospective Trial
- American Association of Physicists in Medicine Task Group 263: Standardizing Nomenclatures in Radiation Oncology
- Motion Management Strategies and Technical Issues Associated with Stereotactic Body Radiotherapy of Thoracic and Upper Abdominal Tumors: A Review from NRG Oncology
- High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: treatment description and preliminary results of a phase I/II clinical trial
- Highly efficient training, refinement, and validation of a knowledge-based plan quality control system for radiotherapy clinical trials
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.