Sexual Function: Quality of Life Issues in Patients with Locally Advanced Non-Metastatic Prostate Cancer

Abstract

Sexual activity is an important aspect of quality of life for most middle-aged and many older men. However, men diagnosed and treated for prostate cancer frequently experience loss of libido and/or erectile dysfunction. Impotence is almost inevitable after non-nerve-sparing radical prostatectomy, but also occurs in 30–75% of patients in whom preservation of the neurovascular bundles is attempted. Erectile dysfunction may also be experienced by up to 50–60% of patients treated by conventional radiotherapy or brachytherapy. In men with more advanced disease, castration (surgical or medical) is associated with a loss of libido, as well as erectile dysfunction. For patients interested in sexual activity, erectile dysfunction can usually be treated. Sildenafil is generally first-line therapy and is effective in 70–80% of post-radiotherapy patients, while in post-radical prostatectomy patients, efficacy is dependent on the presence of the neurovascular bundles. As there are no effective therapies for loss of libido, hormone therapies that help to maintain sexual interest are needed. In large, randomised studies in men with previously untreated locally advanced, non-metastatic (M0) disease, bicalutamide (‘Casodex’) 150 mg monotherapy conferred significant benefits over castration with respect to the maintenance of sexual interest ( p=0.029), while there were no significant differences in survival outcome. Sexual frequency and function were also assessed in one of the three studies comprising the Early Prostate Cancer Programme. The majority of patients randomised to bicalutamide 150 mg retained some sexual activity and function in the first 48 weeks of the study, and approximately one-third maintained their previous levels of sexual activity and function.