- Design
- Prospective international registry cohort
- Population
- 13,413 men treated for localised or locally advanced prostate cancer
- Primary outcome
- EPIC-26 sexual function domain score at 12 months
- Effect
- Median decline -60% after prostatectomy, -40% after brachytherapy; poor or absent erections 64% to 92%
This analysis of the international TrueNTH Global Registry included 13,413 men with localised or locally advanced prostate cancer who reported sexual function 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 decline in the EPIC-26 sexual domain score was largest after prostatectomy (-60%) and smallest after brachytherapy (-40%). At 12 months, 64% to 92% reported poor or absent erectile function, worst after prostatectomy and radiotherapy with hormone therapy. Use of sexual aids rose but remained low.
The registry is not representative and cannot compare treatments fairly. But the scale of loss, and how few men used help, supports frank counselling before treatment and rehabilitation offered routinely rather than on request.
- Record baseline erectile function before any curative prostate treatment
- Tell men that most will have poor erections at one year, whatever the treatment
- Offer PDE5 inhibitors, vacuum devices or injections proactively during follow-up
- Ask about sexual function at every survivorship visit; men rarely raise it
- Involve partners in counselling where the patient wishes
Why it matters
Low use of sexual aids suggests the problem is under-addressed, not untreatable.
Don't overread it
Registry data from non-representative sites; the differences between treatments reflect patient selection as much as the treatment.
The statistics, in plain English
A 60% fall in a function score is a median; some men lose less and some more. Comparisons between treatment groups are associations because men were not randomised.
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