Could uro-oncologists do more to help men on ADT maintain sexual interest and function?

In a recent study, sixty-three uro-oncologists attending an annual British uro-oncology meeting were surveyed about what they offered their patients to manage sexual dysfunction brought on by ADT. The survey was predicated on the observation that less than 20% of ADT patients are offered any interventions to deal with the adverse effects of ADT on sexual function and desire.

The study authors found that clinicians treating prostate cancer were not likely to take on the challenge of also treating patients’ sexual dysfunction. The majority of uro-oncologists, for example, failed to discuss with patients sexual issues either before or after starting on ADT. Nor were those uro-oncologists inclined to do baseline assessment of sexual function or offer management strategies.

The paper includes some quotes from the physicians, which may be viewed as proffered in their own defense. These included statements like "patients on ADT have a low libido and [are] not so bothered" and "many gentlemen decline intervention/referral".

The authors, in contrast, spend some time discussing standard options for treating sexual dysfunction in prostate cancer patients[1]. They note, for example, that most of the surveyed oncologists (92%) had access to sexual dysfunction clinics, to which their patients could be referred. What is implicit in this observation is the idea that the clinics have the tools to help patients who are experiencing sexual dysfunction. What is missing from this paper are data on the specific tools or management strategies that actually work best for patients who are on ADT.

There is much to still be learned about how to help prostate cancer patients and their partners when ADT depresses sexual function and desire.

To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/33260255/

Kinnaird W, Kirby MG, Mitra A, Davda R, Jenkins V, Payne H. The management of sexual dysfunction resulting from radiotherapy and androgen deprivation therapy to treat prostate cancer: A comparison of uro-oncology practice according to disease stage. Int J Clin Pract. 2020 Dec 1:e13873. doi: 10.1111/ijcp.13873. Epub ahead of print. PMID: 33260255.

[1]  There are options for men on ADT that were not mentioned in this paper, but were discussed by our team in previously published papers. These are reviewed in:

Wassersug R, Wibowo E. Non-pharmacological and non-surgical strategies to promote sexual recovery for men with erectile dysfunction. Transl Androl Urol. 2017 Nov;6(Suppl 5):S776-S794.

and

Duthie CJ, Calich HJ, Rapsey CM, Wibowo E. Maintenance of sexual activity following androgen deprivation in males. Crit Rev Oncol Hematol. 2020 Sep;153:103064.