Patterns of sexual and erectile dysfunction and response to treatment in patients receiving androgen deprivation therapy for prostate cancer

OBJECTIVE To investigate the incidence of patient-reported erectile (ED) and sexual dysfunction and response to treatment in men after the induction of androgen deprivation therapy (ADT) for prostate cancer, as ADT-induced changes in serum testosterone can result in changes in libido and sexual function. PATIENTS AND METHODS We retrospectively reviewed patients receiving ADT for prostate cancer at our institution between January 1989 and July 2005; those receiving only neoadjuvant ADT were excluded. Variables included age, race, body mass index, prostate-specific antigen level before ADT, Gleason sum, clinical stage, ADT type (medical vs surgical) and schedule (continuous vs intermittent), previous treatment for prostate cancer, presence of pre-existing or new-onset diabetes mellitus (DM), and presence of ED before ADT. After ADT induction, charts were reviewed for reporting of ED, changes in libido, and initiation of ED therapy (medical or surgical). RESULTS In all, 395 patients (mean age of 71.7 years; 59.0% African-American, 41.0% Caucasian/other, at initiation ADT) were analysed. At mean follow-up of 87.4 months, 57 (14.4%) patients reported ED; 40 of these (70%) reported new-onset ED, while 17 (30%) reported ED before ADT. Response rates were 33-80% with medical therapy, including 44% receiving phosphodiesterase-5 inhibitor monotherapy. On multivariate analysis, age < 70 years (P < 0.001) and the absence of DM (P = 0.024) were associated with reporting ED after ADT. CONCLUSIONS Patients receiving ADT for prostate cancer have variable degrees of ED. Successful outcomes are possible, particularly when implementing multimodal therapy. Younger patients and those with no DM are more likely to report ED after ADT induction.