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EBRT with NADT reduces sexual function, quality of erections in early prostate cancer patients

Tristan Manalac
02 Aug 2017

Health-related quality of life (HRQOL), such as the ability to function sexually and the quality of erections, is worse in patients who undergo external beam radiation therapy (EBRT) with neoadjuvant androgen deprivation therapy (NADT) than in those who receive EBRT alone, a new study shows.

“However, no difference was found in the ability to have an erection, frequency of erections, overall sexual function, hot flashes, breast tenderness/enlargement, depression, lack of energy, or change in body weight,” researchers added.

Longitudinal data of early stage prostate cancer patients enrolled in the PROST-QA consortium, a multicentre study across nine clinical sites across the United States, were used for the study. HRQOL was assessed from 11 questions about sexual and vitality/hormonal function and bothers.

Participants were included if they had received EBRT alone (n=202; median age 69 years), EBRT+NADT (n=86; median age 71 years), brachytherapy alone (BT; n=271; median age 66 years) or BT+NADT (n=14; median age 67 years). Exclusion criteria was previous prostate cancer therapy.

Significantly more participants who underwent EBRT with NADT had lower ability to achieve erections (p=0.0001), worse quality of erections in the past 4 weeks (p<0.0001), less frequent erections in the past 4 weeks (p=0.0001) and poorer ability to reach orgasm (p<0.0001) compared with those who received EBRT alone. [Int J Radiat Oncol Biol Phys 2017;98:304-317]

Additionally, significantly more EBRT+NADT respondents had low self-rating of overall sexual function in the last four weeks (p<0.0001) and lack of energy (p=0.0003). In contrast, there was no significant difference in how big of a problem the sexual function was in the past 4 weeks between the EBRT+NADT and EBRT alone groups (p=0.4622).

“Patients receiving EBRT plus NADT had worse HRQOL, as measured by the frequency of erections, quality of erections, ability to have erections, ability to reach orgasm, ability to function sexually and lack of energy,” researchers said.

“However, when comparing the baseline vs 24-month outcomes, only the differences in the ability to reach orgasms, quality of erections and ability to function sexually were significant,” they added.

Notably, there were no significant differences in responses in any of the sexual and vitality/hormone domain questions in participants who received brachytherapy with or without NADT.

One of the limitations of the current study is the failure to control for the duration of NADT. Most participants, however, received ADT for at most 6 months and the overall length of ADT was restricted to 12 months.

“The improved survival in intermediate- and high-risk patients receiving ADT and EBRT necessitates pretreatment counselling of the HRQOL effects of ADT and EBRT,” said researchers.

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