Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia.
J Urol. 2012 Jun;187(6):2162-6. doi: 10.1016/j.juro.2012.01.080. Epub 2012 Apr 12.
We investigated the effects of testosterone change on the sexual function of men with prostate cancer undergoing intermittent maximal androgen deprivation therapy.
We conducted a phase II cohort study of 250 patients with prostate cancer undergoing intermittent maximal androgen deprivation therapy. Flutamide (Eulexin®) 250 mg 3 times daily and leuprolide (Lucrin®) 22.5 mg were given during a 9-month treatment phase (ONPhase). Therapy was ceased provided that prostate specific antigen was 4 ng/ml or less. Monitoring continued every 3 months for a further 2 years (OFFPhase) unless re-treatment occurred. Sexual function was assessed with the QLQ-PR25 version 3.0 prostate module in conjunction with the QLQ-C30 questionnaire at baseline and every 3 months thereafter.
At baseline 46% of patients reported sexual activity with almost half (43%) reporting mild or no erectile problems. Of the men 63% reported an interest in sex (libido), with 28% reporting moderate to high libido. In addition, 26% felt less masculine as a result of illness or treatment. By 3 months of ONPhase all parameters deteriorated, worsening to a low at 9 months. Only 13% of the men reported sexual activity and 10% reported moderate to high libido. The proportion of men feeling less masculine increased to 50%. During the OFFPhase recovery was observed. Of those previously sexually active men 52% resumed sexual activity. Of these patients all reported erectile function returning to baseline. Levels of libido, masculinity and sexual activity recovered but not to baseline levels.
Libido, sexual activity and perceptions of masculinity deteriorate during ONPhase. Of the sexually active men at baseline half will resume sexual activity despite 9 months of androgen deprivation therapy.
我们研究了睾酮变化对接受间歇性最大雄激素剥夺治疗的前列腺癌男性性功能的影响。
我们对 250 名接受间歇性最大雄激素剥夺治疗的前列腺癌患者进行了一项 II 期队列研究。在 9 个月的治疗期（ON 期）内，每天服用氟他胺（Eulexin®）250mg 3 次和亮丙瑞林（Lucrin®）22.5mg。只要前列腺特异性抗原（PSA）低于 4ng/ml 即停止治疗。在接下来的 2 年内，每 3 个月监测一次（OFF 期），除非重新开始治疗。在基线和之后的每 3 个月，使用 QLQ-PR25 第 3.0 版前列腺模块和 QLQ-C30 问卷评估性功能。
基线时，46%的患者报告有性行为，近一半（43%）报告有轻度或无勃起问题。63%的男性报告有性兴趣（性欲），其中 28%报告有中度到高度的性欲。此外，26%的男性因疾病或治疗而感到缺乏男子气概。在 ON 期的 3 个月时，所有参数都恶化，到 9 个月时降至最低。只有 13%的男性报告有性行为，10%报告有中度到高度的性欲。感到缺乏男子气概的男性比例增加到 50%。在 OFF 期观察到恢复。在以前有性行为的男性中，有 52%恢复了性行为。这些患者均报告勃起功能恢复到基线水平。性欲、男子气概和性行为的水平有所恢复，但未恢复到基线水平。
在 ON 期，性欲、性行为和男子气概感知会恶化。在基线时有性行为的男性中，尽管有 9 个月的雄激素剥夺治疗，仍有一半会恢复性行为。
