Most men lost substantial sexual function after every curative prostate cancer treatment, and few used aids

Design

Prospective international registry cohort

Population

13,413 men treated with prostatectomy, external beam radiotherapy ± ADT, or brachytherapy

Primary outcome

EPIC-26 sexual function domain score at 12 months

Effect

Median decline −60% after prostatectomy, −40% after brachytherapy; poor/absent erections in 64–92%

This analysis of the international TrueNTH Global Registry included 13,413 men with localised or locally advanced prostate cancer who reported outcomes at baseline and 12 months after radical prostatectomy (85%), external beam radiotherapy with or without androgen deprivation, or brachytherapy.

Sexual function fell after every treatment. The median reduction in the EPIC-26 sexual function score was largest after prostatectomy (−60%) and smallest after brachytherapy (−40%). At 12 months, 63.6–91.8% reported poor or absent erectile function, highest after prostatectomy and after radiotherapy with androgen deprivation. Use of sexual aids rose after treatment but remained low.

The figures are worse than many men expect from pre-treatment conversations, and the low use of aids suggests rehabilitation is not being offered or taken up. The authors caution that registry sites are not representative and treatment choice varied between countries, so comparisons between modalities are associations. The consistent message is the need for honest counselling and structured rehabilitation for every treatment, not only surgery.

• Record baseline erectile function with a validated score before any curative treatment
• Give men realistic figures for their chosen treatment, including radiotherapy
• Offer a structured sexual rehabilitation plan, including PDE5 inhibitors, vacuum devices or injections as appropriate
• Involve partners in counselling where the patient wishes
• Review sexual function at each survivorship visit rather than waiting to be asked

Why it matters

Sexual function loss is near-universal after curative treatment, while rehabilitation remains the exception.

Don't overread it

Registry data from non-representative centres — differences between treatments are associations, not a ranking.

The statistics, in plain English

These are median changes from each man's own baseline, so they show how much function was lost rather than absolute levels. Because patients chose their treatments and registry sites differ, the gap between surgery and brachytherapy may partly reflect who received each treatment.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.