Daniel D Joyce1, Christopher J D Wallis2, Amy N Luckenbaugh2, Heather L Huelster2, Zhiguo Zhao3, Karen E Hoffman4, Li-Ching Huang5, Tatsuki Koyama5, Ralph Conwill6, Michael Goodman7, Ann S Hamilton8, Xiao-Cheng Wu9, Lisa E Paddock10, Antoinette Stroup10, Matthew R Cooperberg11, Mia Hashibe12, Brock B O' Neil13, Sherrie H Kaplan14, Sheldon Greenfield14, David F Penson2, Daniel A Barocas2. 1. Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA. daniel.joyce@vumc.org. 2. Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA. 3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. alex.zhao@vumc.org. 4. Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. 6. Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA. 7. Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA. 8. Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA. 9. Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA, USA. 10. Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA. 11. Department of Urology, University of California, San Francisco, San Francisco, CA, USA. 12. Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA. 13. Department of Urology, University of Utah Health, Salt Lake City, UT, USA. 14. Department of Medicine, University of California, Irvine, Irvine, CA, USA.
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.
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.