Androgen deprivation therapy before radical prostatectomy is associated with poorer postoperative erectile function outcomes

OBJECTIVE To define the impact of androgen deprivation therapy (ADT), undergone before radical prostatectomy (RP), on erectile function (EF) recovery. MATERIAL AND METHODS A total of 38 consecutive patients presenting to a sexual medicine clinic after undergoing RP who had received ADT before RP (ADT + group) were compared with a contemporary, age and comorbidity-matched cohort of 94 patients who did not receive ADT (ADT- group) before undergoing RP. Medical records were reviewed for demographics, comorbidity profiles and duration of ADT exposure. All the patients underwent Doppler penile ultrasonography within 6 months of RP and were administered the International Index of Erectile Function (IIEF) questionnaire. All the patients underwent evaluation of EF recovery. We analysed the incidence of venous leak (VL), mean IIEF EF domain score and proportion of men with EF domain scores >= 24 at 18 months after RP. RESULTS The mean age, comorbidity profiles, median Gleason score, median pretreatment PSA level, and mean time to evaluation after RP were similar between the two groups. The median duration of ADT exposure in the ADT + group was 3 months. The incidence of VL within 6 months of surgery was 60% for the ADT + and 20% for the ADT-group (P < 0.001). Likewise, the IIEF EF domain scores and proportion of men with EF domain scores >= 24 at 18 months were significantly lower in the ADT + group, even when controlled for nerve-sparing status. CONCLUSION Our data suggest that preoperative use of ADT adversely impacts EF outcomes and should therefore be avoided in the absence of robust data suggesting any oncological benefit.