Sexual function after prostate cancer surgery or radiotherapy in an international registry

OBJECTIVES: Our objective was to evaluate patient-reported sexual function (SF) outcomes and sexual aid use 12 months after curative treatment for prostate cancer (PC). PATIENTS & METHODS: This prospective registry-based cohort study analysed men with localized or locally advanced PC enrolled in the TrueNTH Global Registry. Patients with baseline and 12-month patient-reported outcome measures after radical prostatectomy (RP), external beam radiotherapy (EBRT) ± androgen-deprivation therapy (ADT), or brachytherapy (BT) were included. SF was assessed using the EPIC-26 sexual function domain score (SFDS). Baseline and 12-month EPIC-26 SFDS were compared by treatment group, with additional analyses among RP patients examining outcomes by intent to nerve spare and sexual aid use. Linear regression, adjusted for age, National Comprehensive Cancer Network risk group, baseline SFDS, and intent to nerve spare was used to identify predictors of 12-month SFDS among surgery patients. RESULTS: Overall, 13 413 men were analysed (RP 85.2%, EBRT only 9.1%, EBRT+ADT 4.3%, BT 1.3%). SF declined significantly across all modalities. Median SFDS reduction was greatest after RP (-60.0%) and smallest after BT (-40.2%). At 12 months, poor or absent erectile function was reported by 63.6-91.8% of patients, highest after RP and EBRT+ADT. Sexual aid use increased after treatment but remained low overall. Given the retrospective design and non-representative sites in an international registry setting, these findings should be interpreted as associational rather than causal because of the potential for unmeasured confounding and cross-country heterogeneity in treatment selection. CONCLUSION: All curative PC treatments were associated with substantial deterioration in SF. These findings support enhanced pre-treatment counselling and early integration of proactive management and structured sexual rehabilitation into survivorship care.