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Sexual function outcomes of radiation and androgen deprivation therapy for localized prostate cancer in men with good baseline function

Prostate Cancer and Prostatic Diseases volume 25, pages 238–247 (2022)Cite this article

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Abstract

Background

Sexual dysfunction, including erectile dysfunction and loss of libido, are common among men undergoing treatment for localized prostate cancer. Both local treatments and systemic androgen deprivation therapy may contribute to these outcomes and are differentially indicated based on disease characteristics. We sought to compare sexual function through 5 years after radiation treatment with and without androgen deprivation therapy in men with good baseline sexual function to better understand long-term effects in this understudied subset of patients.

Methods

We retrospectively reviewed a prospectively assembled population-based cohort of men who underwent radiation with and without androgen deprivation therapy for intermediate or high-risk localized prostate cancer. Sexual function was assessed longitudinally over 5 years. Men with erections sufficient for intercourse at baseline were selected for inclusion.

Results

Out of 167 patients included, 73 underwent radiation alone and 94 received androgen deprivation therapy plus radiation (51 with intermediate and 43 with high-risk disease). Androgen deprivation therapy use was associated with worse sexual function through 1 year regardless of disease risk. This difference was no longer statistically significant at 3 years in the intermediate-risk group. Compared to radiation alone, androgen deprivation therapy in high-risk disease was associated with worse sexual function at 3 years (effect: −20.3 points, CI [−31.8, −8.8], p < 0.001) but not at 5 years (effect: −3.4, CI [−17.2, 10.5], p = 0.63).

Conclusions

Androgen deprivation therapy plus radiation is associated with worse sexual function through 3-years follow-up in men with high-risk prostate cancer compared to radiation alone. The addition of androgen deprivation therapy in the treatment of intermediate-risk disease does not appear to result in worse sexual function at 3 or 5-year follow-up compared to radiation alone.

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Fig. 1: Patient selection criteria.
Fig. 2: Hormone and Sexual Function Outcomes.

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Acknowledgements

We thank the men who participated in CEASAR and shared their experiences. We thank all the study managers, staff, and chart abstractors for their efforts in data collection and help with this study.

Funding

This study was supported by the Agency for Healthcare Research and Quality (1R01HS019356, 1R01HS022640) and the Patient-Centered Outcomes Research Institute (CE-12-11-4667). Data management was facilitated by Vanderbilt University’s Research Electronic Data Capture (REDCap) system, which is supported by the Vanderbilt Institute for Clinical and Translational Research grant (UL1TR000011 from NCATS/NIH).

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Authors and Affiliations

  1. Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA

    Daniel D. Joyce, Christopher J. D. Wallis, Amy N. Luckenbaugh, Heather L. Huelster, David F. Penson & Daniel A. Barocas

  2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Zhiguo Zhao, Li-Ching Huang & Tatsuki Koyama

  3. Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Karen E. Hoffman

  4. Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA

    Ralph Conwill

  5. Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA

    Michael Goodman

  6. Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA

    Ann S. Hamilton

  7. Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA, USA

    Xiao-Cheng Wu

  8. Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA

    Lisa E. Paddock & Antoinette Stroup

  9. Department of Urology, University of California, San Francisco, San Francisco, CA, USA

    Matthew R. Cooperberg

  10. Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Mia Hashibe

  11. Department of Urology, University of Utah Health, Salt Lake City, UT, USA

    Brock B. O’ Neil

  12. Department of Medicine, University of California, Irvine, Irvine, CA, USA

    Sherrie H. Kaplan & Sheldon Greenfield

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  1. Daniel D. Joyce
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Correspondence to Daniel D. Joyce or Zhiguo Zhao.

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Joyce, D.D., Wallis, C.J.D., Luckenbaugh, A.N. et al. Sexual function outcomes of radiation and androgen deprivation therapy for localized prostate cancer in men with good baseline function. Prostate Cancer Prostatic Dis 25, 238–247 (2022). https://doi.org/10.1038/s41391-021-00405-5

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