Continuing Education
for Urology & GU Oncology Clinicians

Washington, DC ( External beam radiotherapy is one of the standard treatment options for patients with localized prostate cancer requiring treatment. In many cases, concomitant androgen deprivation therapy (ADT) is prescribed on account of disease characteristics. In patients with locally advanced prostate cancer (EORTC 22863 and RTOG 86-10)1 and those with localized unfavourable risk disease,2 the addition of ADT has been shown to improve overall survival. However, ADT is well known to be associated with a number of side effects.  

Along with urinary incontinence, erectile dysfunction and decreased sexual function are foremost side effects for patients undergoing treatment of localized prostate cancer and choosing between surgery and radiotherapy based approaches. In a poster presentation at the Society of Urologic Oncology meeting, Dr. Daniel Joyce and colleagues utilized the CEASAR prospective cohort to assess sexual function, and its recovery, among men receiving ADT in conjunction with radiotherapy, compared to radiotherapy alone.

The authors relied on the CEASAR cohort, a prospectively enrolled population-based cohort of men treated for localized prostate cancer.3 Among this group, the authors identified patients treated with radiotherapy, with or without androgen deprivation therapy for intermediate-risk or high risk localized prostate cancer. They then assessed sexual function longitudinally over five years of follow-up using the EPIC-26 measure. Notably, patients who were still receiving ADT at 5 years were excluded from the analysis.

Among 167 patients who met inclusion criteria, 73 received radiotherapy alone and 94 received radiotherapy plus ADT. Pre-treatment sexual function was similar between patients receiving ADT and those who received radiotherapy alone (p=0.22). ADT prescriptions, as we would expect, were influenced by disease characteristics but not baseline sexual function, age or cardiovascular health.

Interestingly, the authors found little difference in sexual function at 3 or 5 years following treatment for patients with intermediate-risk disease who received radiotherapy plus ADT, as compared to radiotherapy alone. In contrast, in patients with high-risk disease who received radiotherapy plus ADT, sexual function was significantly worse at 3 years following treatment and non-significantly worse at 5 years. However, patients in this cohort were significantly less likely to have recovery of erections sufficient for sex at 5 years compared to those who received radiotherapy alone.

Differences between patients with intermediate and risk disease are likely attributable to the duration of ADT and the subsequent recovery of testosterone levels.

Presented by: Daniel D. Joyce, MD, Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee 

Written by: Christopher J.D. Wallis, MD, PhD, FRCSC, @WallisCJD on Twitter at the 20th Annual Meeting of the Society of Urologic Oncology (SUO), December 4 - 6, 2019, Washington, DC


1. Bolla M, Gonzalez D, Warde P, et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. The New England journal of medicine 1997; 337(5): 295-300. 

2. D'Amico AV, Chen MH, Renshaw AA, Loffredo M, Kantoff PW. Androgen suppression and radiation vs radiation alone for prostate cancer: a randomized trial. JAMA : the journal of the American Medical Association 2008; 299(3): 289-95. 

3. Barocas DA, Alvarez J, Resnick MJ, et al. Association Between Radiation Therapy, Surgery, or Observation for Localized Prostate Cancer and Patient-Reported Outcomes After 3 Years. JAMA : the journal of the American Medical Association 2017; 317(11): 1126-40.