Patient Reported Sexual Aid Utilization and Efficacy following Radiation Therapy for Localized Prostate Cancer

Publication date: Available online 31 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Robert T. Dess, Theresa P. Devasia, Nima Aghdam, William C. Jackson, Payal D. Soni, Clayton P. Smith, Amyre L. Mitchell, Simeng Suy, Daniel A. Hamstra, Shruti Jolly, Paul L. Nguyen, Felix Y. Feng, Matthew J. Schipper, Ted A. Skolarus, David C. Miller, Daniela A. Wittmann, Sean P. Collins, Daniel E. Spratt
PurposeErectile dysfunction is common after treatment for localized prostate cancer. Longitudinal data regarding medication and device practice patterns and efficacy in men treated are lacking. Herein, we report sexual health related quality of life (HRQOL) outcomes and utilization and efficacy of sexual aids in a contemporary cohort.Materials and MethodsBetween 2008-2013, 471 consecutive men with localized prostate cancer were treated on two institutional protocols (NCTXXXXXXXX, NCTXXXXXXXX) or on a prospective institutional registry with patient-reported HRQOL. All patients were treated with ultra-hypofractionated radiotherapy. Erectile function (EF) was defined as "firm enough for intercourse" with or without aids per EPIC-26 (n=222 at baseline); results apply to this cohort unless specifically noted. Sexual aid utilization and efficacy was patient-reported. Multivariable-analysis of EF was performed.ResultsMedian follow-up was 60 months, median age was 67, and 70% had intermediate- or high-risk disease per NCCN. At 24 and 60 months, questionnaire response rates were 86% and 67%, and EF was retained in 53% and 41%, respectively. Baseline sexual aid utilization was 37% (n=82) and was associated with lower 24-month EF preservation on multivariable-analysis (adjusted-odds-ratio: 0.49 95%CI 0.26-0.92). By 60 months, 70% of men had tried aids. Of those who found aids helpful at baseline, 84-89% reported continued benefit at 24-60 months. Among aid-naïve patients, efficacy was 80% with first-time use within 12 months and 70% >12 months post-radiotherapy (p=0.02). Among men who developed erectile dysfunction, but found sexual aids helpful, 25% were not current users at 60 months.ConclusionsOne third of men utilized sexual aids at baseline, which doubled by 5-years post-radiotherapy. Self-reported efficacy was high, and sustained. Despite significant declines in EF, a number of men reported helpfulness of aids, but were not active users. Future study is required to understand drivers of aid utilization to optimize post-treatment sexual function.

Teaser

Among a prospectively followed cohort of 471 men treated with radiation therapy for prostate cancer, we demonstrate that sexual aid use is common at baseline, increases with time, and is helpful to many. However, a substantial number of men reported benefit, but were not currently using aids, and future study is required to optimize post-treatment sexual function.


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