Sexual quality of life after stereotactic body radiotherapy and androgen deprivation therapy for prostate cancer: A single-institution observational study

Sexual quality of life (QOL) of prostate cancer (PCa) patients is severely impacted following curative treatment, yet remains infrequently discussed. The objective was to report the sexual QOL outcome of PCa patients treated by stereotactic body radiotherapy (SBRT) and androgen deprivation therapy (ADT). A total of 53 PCa patients across National Comprehensive Cancer Network risk categories with at least six months of follow-up were included in this study. Sexual symptom scores were assessed before SBRT and at 6, 12, 18, 24, and 36 months after treatment using the Expanded Prostate Cancer Index Composite for Clinical Practice questionnaire. The mean dose to the penile bulb (Dmean) and dose received by the bilateral neurovascular bundle (NVB) were documented. The mean sexual symptoms score was 5.06 pre-SBRT, increasing to 8.2 at 18 months post-SBRT and subsequently decreasing to 7.4 and 6.25 at 24 and 36 months post-SBRT, respectively, suggesting a potential recovery of sexual QOL beyond 2 years. The median Dmean to the penile bulb was 20.6 Gy, and median V34.4, V32, and V28 of the NVB were 88.4%, 96.7%, and 99.9%, respectively. SBRT combined with ADT was associated with a low observed frequency of biochemical failure and a decline in sexual QOL in this cohort. Larger prospective studies incorporating NVB-sparing strategies are needed to clarify the determinants of post-treatment sexual QOL.