Sexual dysfunction in men after radiotherapy for squamous cell carcinoma of the Anus: A danish anal cancer group DACG study

Sexual dysfunction, particularly erectile dysfunction (ED), is well documented after pelvic radiotherapy, but evidence in men with squamous cell carcinoma of the anus (SCCA) remains sparse.

To assess erectile and ejaculatory function, and sexual interest up to five years after curative-intent radiotherapy for SCCA, based on physician-graded toxicity and validated patient-reported outcomes (PROs).

This sub-study of the prospective DACG-I cohort (NCT05570279) included men treated with curative-intent radiotherapy for SCCA (2015-2020). PROs (EORTC QLQ-C30 and QLQ-CR29) and physician-graded toxicity (CTCAE v4.0) were collected at baseline, 1, 3, and 5-years. Symptom prevalences were described descriptively. Longitudinal changes were assessed using linear mixed-effects models on linearly transformed EORTC scores.

Of 80 enrolled men, baseline data were available for 76. At baseline, majority were symptom-free. Erectile and ejaculatory dysfunction emerged mainly within 1-3 years after treatment and persisted through 5 years. For the total cohort, ejaculatory dysfunction increased from 4.5% at baseline to 12.3% at 3 years. Physician-assessed ED (NCI-CTCAE grade ≥ 2) increased from 11.9% to 39.3% at 3 years. PROs indicated greater deterioration in erectile function at parallel time points. EORTC scores confirmed moderate-to-major clinically important deterioration at 1 and 3 years. Sexual interest remained stable over time.

Sexual dysfunction, particularly ED, represents an increasingly prevalent and persistent late adverse effect in men treated with curative-intent radiotherapy for SCCA. The early onset of symptoms and the limited extent of recovery underscore the need for structured assessment based on PROs to support timely identification and supportive care.