Impact of androgen deprivation therapy on sexual health in patients who underwent brachytherapy for prostate cancer.

BACKGROUND

Androgen deprivation therapy (ADT) is used in the management of prostate cancer. Post-therapy recovery from the induced hypogonadal state is protracted and correlates with diminished quality of life (QOL).

OBJECTIVE

This study assessed the impact of short-term ADT on sexual health following brachytherapy.

MATERIALS AND METHODS

The study included patients administered brachytherapy with or without short-term neoadjuvant ADT (≤6 months) at our institution from 2010 to 2018. Serum total testosterone levels, chronological changes in erectile function, and health-related QOL were evaluated.

RESULTS

Of 139 participants, 41 received neoadjuvant ADT (median, 4 months). Sexual health inventory for men (SHIM) scores and sexual function domain of the expanded prostate cancer index composite (EPIC) scores deteriorated significantly up to 36 months post-treatment in patients receiving brachytherapy with neoadjuvant ADT compared to those without. A significant decline was observed in the sexual bother domain of the EPIC scores of patients without neoadjuvant ADT up to 6 months post-treatment relative to those with neoadjuvant ADT. Total testosterone levels in the brachytherapy with neoadjuvant ADT group gradually recovered post-treatment and were similar to those in the brachytherapy without neoadjuvant ADT group after 12-month treatment. Neoadjuvant ADT and a lower pre-treatment SHIM score were risk factors for severe erectile dysfunction 12 months after treatment.

DISCUSSION

Restoring sexual health extends beyond the normalization of testosterone levels following cessation of ADT. ADT significantly influences erectile dysfunction after brachytherapy. Our research identified a time lag between the restoration of testosterone levels and the improvement of erectile function and sexual QOL. We hypothesized that individuals undergoing ADT had diminished sexual distress, attributable to fewer opportunities for sexual engagement than their untreated counterparts.

CONCLUSION

Persistent sexual dysfunction occurs despite the normalization of testosterone levels post-ADT. Understanding sexual QOL changes following brachytherapy with ADT will help guide treatment recommendations and patient decision-making.