3296 - Sexual Function after Radiation Therapy: Long-Term Outcomes and Real-World Effectiveness of Sexual Medicines and Devices
Presenter(s)
S. Y. Kim-Wang1, M. Patel2, G. Rajeev-Kumar3, Y. Che4, C. H. Son5, and S. Liauw1; 1Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, 2UChicago Medicine, Chicago, IL, United States, 3Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL, 4Department of Public Health Sciences, University of Chicago, Chicago, IL, 5Department of Radiation Oncology, University of Illinois Chicago, Chicago, IL
Purpose/Objective(s): Radiation therapy (RT) for prostate cancer can compromise sexual health, yet longitudinal patterns of recovery and the real-world use and effectiveness of sexual medicines and devices remain incompletely characterized. We evaluated long-term sexual outcomes after RT and assessed utilization and perceived benefit of sexual aids.
Materials/Methods: 597 men with prostate cancer were treated with curative-intent intensity modulated RT between 2006–2023. Patient characteristics, treatment details, and patient-reported outcomes (EPIC-26), including a survey of sexual medicine and device utilization, were prospectively recorded in an IRB-approved database. Global sexual score was analyzed longitudinally using generalized estimating equations. Analyses were performed for the overall cohort and a predefined subset of 233 men with good baseline sexual health (moderate or better erectile function). Median follow-up was 52 months.
Results: Median age was 69 years (IQR 64-75); 26% had diabetes. Median dose was 78 Gy/39 fx for conventional (n=410) and 60 Gy/20 fx for hypofractionated RT (n=187); pelvic nodes were included in 22%. NCCN risk category distribution was low (5.7%), favorable intermediate (11.4%), unfavorable intermediate (28.3%), and high (54.6%). Androgen deprivation therapy (ADT) was given in 401 (68%) men for a median of 19 months (IQR 6-27).
Median global sexual score declined from 65 points at baseline to 34 points at 2 years, with partial recovery at 4 years (44 points) and 5 years (51 points). Approximately 40–50% of men experienced a decline =2× the minimum clinically important difference (=20 points). On multivariable analysis, only ADT was associated with lower global sexual score in both the overall cohort and the good baseline subset (ß -10.6, p<0.01). Age (p=0.38), diabetes (p=0.12), NCCN risk category (p=0.26), and nodal RT (p=0.73) were not significantly associated. Among men with good baseline function, oral phosphodiesterase inhibitors were the most commonly utilized aid (35% at baseline), while vacuum, urethral, and injectable therapies were each used by =5%. Oral medication use (40%, 39% and 59% at 2, 4, and 5 years, respectively; p=0.35), and reported benefit among users remained stable (87%, 68%, 74%, and 86% at baseline, 2, 4, and 5 years; p=0.99). There was no difference in the percentage of men reporting moderate to severe sexual bother over time (20% at baseline, 38% at 2, 31% at 4, and 31% at 5 years, p=0.51).Conclusion: Sexual function declines after RT for prostate cancer, particularly with concurrent ADT. Utilization of sexual medicines and devices and perceived benefit remain stable beyond 2 years. These findings suggest that sexual aids remain effective for selected men following RT.