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Sexual Dysfunction in Prostate Cancer Patients According to Disease Stage and Treatment Modality.

W Kinnaird1, P Schartau2, M Kirby3

  • 1University College London, Gower Street, WC1E 6BT, London, UK; University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK.

Clinical Oncology (Royal College of Radiologists (Great Britain))
|March 25, 2025
PubMed
Summary

Prostate cancer (PCa) treatments cause widespread sexual dysfunction (SD) in over 98% of patients, impacting physical and psychological well-being. Advanced disease and combination therapies worsen these effects, highlighting the need for comprehensive rehabilitation.

Keywords:
Biopsychosocialerectile dysfunctionprostate carcinomaquality of lifesexual dysfunctionsexual side effects

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Area of Science:

  • Oncology
  • Urology
  • Sexual Medicine

Background:

  • Prostate cancer (PCa) diagnosis and treatment significantly impact patients' quality of life.
  • Sexual dysfunction (SD) is a prevalent and distressing side effect, affecting physical and psychological domains.
  • Understanding the nuances of SD across different disease stages and treatment modalities is crucial for patient care.

Purpose of the Study:

  • To investigate the prevalence and characteristics of physical and psychological sexual dysfunction (SD) in prostate cancer (PCa) patients.
  • To analyze how disease stage and treatment modality influence the experience of sexual side effects.
  • To identify patient support needs related to sexual recovery.

Main Methods:

  • An online survey was administered to 654 PCa patients assessing sexual side effects across 13 domains, sexual function importance, and support needs.
  • Data on disease stage (localised, locally advanced, advanced) and treatment (radical prostatectomy, radiotherapy, androgen deprivation therapy) were collected.
  • Descriptive statistics and chi-squared tests were used for data analysis.

Main Results:

  • Over 98% of PCa patients reported new-onset sexual problems post-treatment.
  • Common physical dysfunctions included erectile dysfunction (91.0%), ejaculatory disturbance (82.9%), and anatomical penile change (70.0%).
  • Psychosexual dysfunctions were prevalent, with loss of sexual confidence (76.2%), loss of sex drive (67.1%), and loss of self-esteem (57.1%) being most common. Advanced disease and combination therapies (RP, RT, ADT) were associated with higher SD rates.

Conclusions:

  • Sexual dysfunction is a common, severe, and distressing consequence of PCa treatment, with patients valuing sexual recovery highly.
  • Patients with advanced PCa and those undergoing combination therapies, especially permanent ADT, experience the most severe SD, including significant psychosexual issues.
  • Holistic rehabilitation strategies addressing a wide spectrum of sexual side effects are essential for all PCa survivors, particularly those on long-term ADT.