Effect of hormonal therapy on satisfaction rates after penile prosthesis surgery in prostate cancer survivors

Abstract

Background: Prostate cancer, a prevalent malignancy in men, often results in erectile dysfunction (ED), particularly following treatments like radical prostatectomy (RP) and radiotherapy, significantly affecting quality of life. Managing ED in prostate cancer survivors is critical. Inflatable penile prosthesis (IPP) implantation is a well-established treatment for ED, yet the literature on satisfaction rates for patients with a history of androgen deprivation therapy (ADT) remains sparse. We aimed to investigate the impact of ADT on satisfaction rates in patients undergoing IPP implantation following RP or radiation therapy (XRT).

Methods: A retrospective review of 529 patient charts identified 96 eligible patients who underwent IPP implantation post-prostate cancer treatment and completed the 11-item Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Patients were stratified into two groups based on ADT status, and their satisfaction scores were compared. Effect sizes were used to assess clinical relevance alongside statistical significance (p = 0.0344).

Results: Patients receiving ADT had significantly lower EDITS scores (p = 0.0344) compared to those not on ADT. RP patients reported higher satisfaction post-IPP compared to XRT patients, even after controlling for ADT. Additionally, coronary artery disease (CAD) was associated with lower satisfaction scores.

Conclusion: ADT significantly lowers patient satisfaction post-IPP, with RP patients generally reporting higher satisfaction than XRT patients. These findings highlight the importance of counseling prostate cancer patients on ADT's impact on long-term sexual satisfaction and suggest areas for further research to enhance outcomes.

Keywords

androgen deprivation therapy / erectile dysfunction / men's health / penile prosthesis / prostate cancer / sexual satisfaction

References

[1] Penson DF , Rossignol M , Sartor AO , Scardino PT , Abenhaim LL . Prostate cancer: epidemiology and health-related quality of life. Urology. 2008; 72 (Suppl 6): S3- 11.

[2] Bartzatt R . Prostate cancer: biology, incidence, detection methods, treatment methods, and vaccines. Curr Top Med Chem. 2020; 20 (10): 847- 54.

[3] Litwin MS , Tan HJ . The diagnosis and treatment of prostate cancer: a review. JAMA. 2017; 317 (24): 2532- 42.

[4] Bekelman JE , Rumble RB , Chen RC , Pisansky TM , Finelli A , Feifer A , et al. Clinically Localized Prostate Cancer: ASCO Clinical Practice Guideline Endorsement of an American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology Guideline. J Clin Oncol. 2018; 36 (32): 3251- 8.

[5] Nguyen-Nielsen M , Møller H , Tjønneland A , Borre M . Patient-reported outcome measures after treatment for prostate cancer: results from the Danish Prostate Cancer Registry (DAPROCAdata). Cancer Epidemiol. 2020; 64: 101623.

[6] Skolarus TA , Wolf AM , Erb NL , Brooks DD , Rivers BM , Underwood W , et al. American Cancer Society prostate cancer survivorship care guidelines. CA Cancer J Clin. 2014 Jul-Aug; 64 (4): 225- 49.

[7] Walker LM , Santos-Iglesias P , Robinson J . Mood, sexuality, and relational intimacy after starting androgen deprivation therapy: implications for couples. Support Care Cancer. 2018; 26 (11): 3835- 42.

[8] DiBenedetti DB , Gondek K , Sagnier PP , Kubin M , Marquis P , Keininger D , et al. The treatment satisfaction scale: a multidimensional instrument for the assessment of treatment satisfaction for erectile dysfunction patients and their partners. Eur Urol. 2005; 48 (3): 503- 11.

[9] Menard J , Tremeaux JC , Faix A , Pierrevelcin J , Staerman F . Erectile function and sexual satisfaction before and after penile prosthesis implantation in radical prostatectomy patients: a comparison with patients with vasculogenic erectile dysfunction. J Sex Med. 2011; 8 (12): 3479- 86.

[10] Carter J , Lacchetti C , Andersen BL , Barton DL , Bolte S , Damast S , et al. Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline. J Clin Oncol. 2018; 36 (5): 492- 511.

[11] Cappelleri JC , Tseng LJ , Stecher VJ , Althof SE . Clinically important difference on the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire in patients with erectile dysfunction. Int J Clin Pract. 2018; 72 (4): e13073.

[12] Jones JM , Kohli M , Loprinzi CL . Androgen deprivation therapy-associated vasomotor symptoms. Asian J Androl. 2012; 14 (2): 193- 7.

[13] DiBlasio CJ , Malcolm JB , Derweesh IH , Womack JH , Kincade MC , Mancini JG , et al. Patterns of sexual and erectile dysfunction and response to treatment in patients receiving androgen deprivation therapy for prostate cancer. BJU Int. 2008; 102 (1): 39- 43.

[14] Parekh A , Chen MH , Hoffman KE , Choueiri TK , Hu JC , Bennett CL , et al. Reduced penile size and treatment regret in men with recurrent prostate cancer after surgery, radiotherapy plus androgen deprivation, or radiotherapy alone. Urology. 2013; 81 (1): 130- 5.

[15] Park KK , Lee SH , Chung BH . The effects of long-term androgen deprivation therapy on penile length in patients with prostate cancer: a single-center, prospective, open-label, observational study. J Sex Med. 2011; 8 (11): 3214- 9.

[16] Shen C , Jain K , Shah T , Schaefer E , Zhou S , Fried D , et al. Relationships between erectile dysfunction, prostate cancer treatment type and inflatable penile prosthesis implantation. Investig Clin Urol. 2022; 63 (3): 316- 24.

[17] Rogers MJ , Ramirez-Fort MK , Kashanian JA , Broster SA , Matta J , Mahase SS , et al. Prostatic irradiation-induced sexual dysfunction: a review and multidisciplinary guide to management in the radical radiotherapy era (Part II on Urological Management). Rep Pract Oncol Radiother. 2020; 25 (4): 619- 24.

[18] Potosky AL , Davis WW , Hoffman RM , Stanford JL , Stephenson RA , Penson DF , et al. Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the prostate cancer outcomes study. J Natl Cancer Inst. 2004; 96 (18): 1358- 67.

[19] Lane JA , Donovan JL , Young GJ , Davis M , Walsh EI , Avery KNL , et al. Functional and quality of life outcomes of localised prostate cancer treatments (Prostate Testing for Cancer and Treatment [ProtecT] study). BJU Int. 2022; 130 (3): 370- 80.

[20] Mazariego CG , Egger S , King MT , Juraskova I , Woo H , Berry M , et al. Fifteen year quality of life outcomes in men with localised prostate cancer: population based Australian prospective study. BMJ. 2020; 371: m3503.

[21] Mazzola CR , Deveci S , Heck M , Mulhall JP . Androgen deprivation therapy before radical prostatectomy is associated with poorer postoperative erectile function outcomes. BJU Int. 2012; 110 (1): 112- 6.

[22] Joyce DD , Wallis CJD , Luckenbaugh AN , Huelster HL , Zhao Z , Hoffman KE , et al. Sexual function outcomes of radiation and androgen deprivation therapy for localized prostate cancer in men with good baseline function. Prostate Cancer Prostatic Dis. 2022; 25 (2): 238- 47.

[23] Shao K , Chen W , Li Y , Zheng H , Hu R , Zhang J , et al. Effects of heart failure and coronary artery disease on erectile dysfunction: a two-sample mendelian randomization study. BMC Urol. 2023; 23: 163.

[24] Solomon H , Man JW , Wierzbicki AS , Jackson G . Relation of erectile dysfunction to angiographic coronary artery disease. Am J Cardiol. 2003; 91 (2): 230- 1.

[25] Mikhail N . Does testosterone have a role in erectile function? Am J Med. 2006; 119 (5): 373- 82.

RIGHTS & PERMISSIONS

The Author(s). UroPrecision published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.