What happened? Sexual consequences of prostate cancer and its treatment.

OBJECTIVE

To describe the sexual consequences of prostate cancer and its treatments (prostatectomy, external beam radiation, brachytherapy, androgen deprivation therapy) and to suggest treatments for sexual side effects of these therapies.

QUALITY OF EVIDENCE

Most studies of the sexual consequences of prostate cancer treatments and studies of therapy for these side effects provide level II evidence.

MAIN MESSAGE

Diagnosis of prostate cancer in itself can cause sexual dysfunction. All forms of treatment for this cancer cause serious sexual problems for men. Treatments for the erectile dysfunction that results have varying success rates. Prostatectomy has been shown to cause erectile dysfunction in 30% to 98% of men, depending on whether both, one, or neither nerve bundles was spared. Radiation therapy results in erectile dysfunction in more than 70% of those treated; brachytherapy produces the least amount of sexual deficit. Hormone ablation therapy has serious consequences: more than 80% of men report loss of erections at 1 year after therapy in addition to profound loss of libido.

CONCLUSION

Family physicians are ideally placed to provide anticipatory guidance to men with prostate cancer on the sexual consequences of both the cancer and its treatments. Family physicians can also assist men and their partners in managing these sexual side effects.