{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T06:30:47Z","timestamp":1772605847126,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"24","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008497","name":"Boston Scientific Corporation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rectal spacers have been shown in clinical studies to reduce side effects of radiotherapy (RT) in prostate cancer (PCa) patients. In addition, secondary analyses also showed reduced erectile dysfunction following PCa RT with the use of a rectal spacer. However, this association with erectile dysfunction (ED) in large\u2010scale real\u2010world settings remains unexplored. This study evaluated the association between rectal spacer use and the prevalence of ED diagnosis among PCa patients receiving prostate RT at the US county level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study utilized Medicare 5% and 100% Standard Analytic Files to analyze county\u2010level data. The analytical sample included adult PCa patients receiving RT\u2014comprising stereotactic body radiation therapy (SBRT), intensity\u2010modulated radiation therapy (IMRT), proton beam radiation therapy, and brachytherapy\u2014between January 2015 and March 2023. The primary outcome was the county\u2010level proportion of RT patients diagnosed with ED between January 2015 and March 2023. The primary explanatory variable was the proportion of patients receiving prostate RT utilizing a rectal spacer from 1 to 5\u2009years prior to an ED diagnosis. Zero\u2010inflated Poisson regression models were used to assess the association between rectal spacer use and ED prevalence at the county level, controlling for county\u2010level PCa patient characteristics (median age and racial composition) and general population characteristics (median age, racial composition, and median household income). State\u2010level fixed effects accounted for regional variation. Data for general population characteristics were obtained from the 2020 Agency for Healthcare Research and Quality Social Determinants of Health Database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study included 247,250 PCa patients who underwent RT across 3132\u2009US counties between January 2015 and March 2023. The average annual prevalence of ED among PCa patients receiving RT at the county level was 1.3%. During the study period, the proportion of patients receiving rectal spacers increased from 2.9% to 18.9%. After adjusting for confounders, counties with higher rectal spacer use 4\u20135\u2009years prior had a significantly lower prevalence of ED: a 10\u2010percentage point increase in rectal spacer use at the county level was associated with a 7.7% relative reduction in ED prevalence after 4\u2009years (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and an 8.4% reduction after 5\u2009years (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This is the first large\u2010scale real\u2010world analysis to demonstrate an association between rectal spacer use and ED prevalence among PCa patients undergoing RT. County\u2010level analysis suggests that increased use of rectal spacing among PCa patients receiving RT is associated with a significantly lower prevalence of ED, with benefits emerging after a 4\u20135\u2010year time lag. These findings support the long\u2010term benefit of rectal spacer use in preserving sexual function in PCa patients undergoing prostate RT. Future research should evaluate the etiology of the delayed benefit observed in this study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71362","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T13:04:17Z","timestamp":1765631057000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Rectal Spacer Use and Erectile Dysfunction Diagnosis Among Men Receiving Prostate Radiotherapy:\n                    <scp>US<\/scp>\n                    County\u2010Level Analysis"],"prefix":"10.1002","volume":"14","author":[{"given":"Ryan","family":"Hankins","sequence":"first","affiliation":[{"name":"Department of General Urology MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean P.","family":"Collins","sequence":"additional","affiliation":[{"name":"Radiation Oncology Morsani School of 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A.","family":"Hamstra","sequence":"additional","affiliation":[{"name":"Radiation Oncology Baylor College of Medicine  Houston Texas 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