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Sexuality of prostate cancer patients following radical prostatectomy

https://doi.org/10.21886/2308-6424-2025-13-2-92-102

Abstract

Radical prostatectomy (RPE) represents the gold standard for radical surgical management of non-metastatic prostate cancer (PCa). While robot-assisted and laparoscopic RPE modalities offer distinct advantages, they are also associated with various complications, notably sexual dysfunction. Sexual disorders following PCa treatment are highly prevalent and exert a profound impact on patients’ quality of life, self-esteem, and interpersonal relationships within both familial and professional spheres. The primary treatment modalities for prostate cancer frequently result in a spectrum of sexual disorders, encompassing erectile and orgasmic dysfunction, diminished libido, androgen deprivation symptoms, as well as alterations in penile morphology characterized by reductions in length and girth, along with penile curvature. The objective of this review was to critically evaluate the accumulated body of evidence pertaining to the diagnosis and management of sexual dysfunctions following RPE. The analysis incorporated peer-reviewed articles authored by both international and domestic researchers spanning the period from 2014 to 2024, in addition to foundational literature predating this period and comprehensive sources addressing sexual dysfunction in PCa patients post-RPE. The findings of our review underscore the multifaceted nature of sexual disorders encountered in patients following RPE, thereby corroborating the escalating necessity for the development and implementation of innovative interventions aimed at enhancing sexual health outcomes in patients undergoing radical prostate surgery.

About the Authors

M. E. Efremov
Kuban State Medical University ; Research Institute — Ochapovsky Krasnodar Regional Clinical Hospital No.1
Russian Federation

Mikhail E. Efremov — Сand.Sc.(Med) 

 Krasnodar 


Competing Interests:

The authors declare no conflict of interest. 



A. D. Anosov
Kuban State Medical University ; Research Institute — Ochapovsky Krasnodar Regional Clinical Hospital No.1
Russian Federation

Anatoly D. Anosov 

Krasnodar 


Competing Interests:

The authors declare no conflict of interest. 



V. L. Medvedev
Kuban State Medical University ; Research Institute — Ochapovsky Krasnodar Regional Clinical Hospital No.1
Russian Federation

Vladimir L. Medvedev — Dr.Sc. (Med.), Full Prof. 

Krasnodar 


Competing Interests:

The authors declare no conflict of interest. 



M. I. Kogan
Rostov State Medical University
Russian Federation

Mikhail I. Kogan — Dr.Sc.(Med), Full Prof., Hons. Sci. of the Russian Federation 

Rostov-on-Don 


Competing Interests:

The authors declare no conflict of interest. 



References

1. Culp MB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. Recent Global Patterns in Prostate Cancer Incidence and Mortality Rates. Eur Urol. 2020;77(1):38-52. DOI: 10.1016/j.eururo.2019.08.005

2. Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, Bray F. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021 Apr 5. DOI: 10.1002/ijc.33588

3. Nosov D.A., Volkova M.I., Gladkov O.A., Karabina E.V., Krylov V.V., Matveev V.B., Usychkin S.V., Mitin T. Rak predstatel’noi zhelezy. Zlokachestvennye opukholi. 2023;13(3s2-1):640-660. (In Russian). DOI: 10.18027/2224-5057-2023-13-3s2-1-640-660

4. Chebbi A. Dysfonctions sexuelles après traitement du cancer de la prostate [Sexual dysfunction after prostate cancer treatment]. Rev Prat. 2023;73(8):879-884. (In French). PMID: 38354013

5. EAU Guidelines on prostate cancer. Edn. presented at the EAU Annual Congress Paris 2024. ISBN 978-94-92671-23-3. URL: https://uroweb.org/guidelines/prostate-cancer

6. Shiraishi K. Evaluation of sexual function after robot-assisted radical prostatectomy: A farewell to IIEF questionnaire. Int J Urol. 2023;30(11):959-967. DOI: 10.1111/iju.15264

7. Colson MH, Lechevallier E, Rambeaud JJ, Alimi JC, Faix A, Gravis G, Hannoun-Levi JM, Quintens H, Rébillard X, Droupy S. Sexualité et cancer de la prostate [Sexuality and prostate cancer]. Prog Urol. 2012;22 Suppl 2:S72-92. (In French). DOI: 10.1016/S1166-7087(12)70039-8

8. Wittmann D, Northouse L, Crossley H, Miller D, Dunn R, Nidetz J, Montie J, Moyad M, Lavin K, Montie JE. A pilot study of potential pre-operative barriers to couples’ sexual recovery after radical prostatectomy for prostate cancer. J Sex Marital Ther. 2015;41(2):155-168. DOI: 10.1080/0092623X.2013.842194

9. Chung E, Gillman M. Prostate cancer survivorship: a review of erectile dysfunction and penile rehabilitation after prostate cancer therapy. Med J Aust. 2014;200(10):582-585. DOI: 10.5694/mja13.11028

10. Chung E. Male sexual dysfunction and rehabilitation strategies in the settings of salvage prostate cancer treatment. Int J Impot Res. 2021;33(4):457-463. DOI: 10.1038/s41443-021-00437-4

11. Greimel E, Nagele E, Lanceley A, Oberguggenberger AS, Nordin A, Kuljanic K, Arraras JI, Wei-Chu C, Jensen PT, Tomaszewski KA, Creutzberg CL, Galalae R, Toelen H, Zimmermann K, Bjelic-Radisic V, Costantini A, Almont T, Serpentini S, Paskeviciute Frøding L, Vistad I, Schmalz C; EORTC Quality of Life Group. Psychometric validation of the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire Sexual Health (EORTC QLQ-SH22). Eur J Cancer. 2021;154:235-245. DOI: 10.1016/j.ejca.2021.06.003

12. Schoentgen N, Marolleau J, Delage F, Coquet JB, Fourcade A, Callerot P, Serey-Eiffel S, Malhaire JP, Pradier O, Schick U, Fournier G, Valeri A. Prospective four years of evaluation of erectile function after lowdose-rate prostate brachytherapy using baseline IIEF-5 > 16. J Contemp Brachytherapy. 2019;11(3):195-200. DOI: 10.5114/jcb.2019.85793

13. O’Leary E, Drummond FJ, Gavin A, Kinnear H, Sharp L. Psychometric evaluation of the EORTC QLQ-PR25 questionnaire in assessing healthrelated quality of life in prostate cancer survivors: a curate’s egg. Qual Life Res. 2015;24(9):2219-2230. DOI: 10.1007/s11136-015-0958-y

14. Crump RT, Peterson A, Charbonneau C, Carlson KV, Sutherland JM, Baverstock RJ. Evaluating the measurement properties of the 26-item Expanded Prostate Cancer Index Composite (EPIC-26) with a multicenter cohort. Can Urol Assoc J. 2020;14(4):111-117. DOI: 10.5489/cuaj.5997

15. Pikramenos K, Zachou M, Papadopoulos D, Papatsoris A, Varkarakis I, Mitsogiannis I. Post Radical Prostatectomy Erectile Dysfunction. A Single Centre Experience. Cureus. 2023;15(2):e34601. DOI: 10.7759/cureus.34601

16. Zakhour S, Sardinha A, Levitan M, Berger W, Nardi AE. Instruments for assessing sexual dysfunction in Arabic: A systematic literature review. Transcult Psychiatry. 2022;59(6):819-830. DOI: 10.1177/13634615221105120

17. Woo SH, Kang DI, Ha YS, Salmasi AH, Kim JH, Lee DH, Kim WJ, Kim IY. Comprehensive analysis of sexual function outcome in prostate cancer patients after robot-assisted radical prostatectomy. J Endourol. 2014;28(2):172-177. DOI: 10.1089/end.2013.0304

18. Loran O.B., Segal A.S. The scale of quantitative assessment of male copulatory function (ICF scale). Urologiya i nefrologiya = Urology and nephrology. 1998;(5):24-27. (In Russian).

19. Kireev A.Y. A New approach to the assessment male sexuality in symptomatic benign prostatic hyperplasia (rostov questionnaire). Urology Herald. 2013;(2):30-37. (In Russian). DOI: 10.21886/2308-6424-2013-0-2-30-37

20. EAU Guidelines on sexual and reproductive health. Edn. presented at the EAU Annual Congress Paris April 2024. ISBN 978-94-92671-23-3. URL: https://uroweb.org/guidelines/sexual-and-reproductive-health

21. Karnaukh P.A., Jaitcev S.V., Vazhenin A.V., Zolotykh M.A., Peretruhin A.A. Prevention and treatment of erectile dysfunction in patients after radical nervesparing prostatectomy. Urology Herald. 2015;(4):50-64. (In Russian). DOI: 10.21886/2308-6424-2015-0-4-50-64

22. Mi Z, Liu J, Wang L, Luo Y, Yang K. Screening of Associated Factors for Erectile Dysfunction after Radical Prostatectomy and Construction of a Clinical Risk Assessment Model: A Retrospective Study. Arch Esp Urol. 2024;77(1):92-97. DOI: 10.56434/j.arch.esp.urol.20247701.12

23. Frey AU, Sønksen J, Fode M. Neglected side effects after radical prostatectomy: a systematic review. J Sex Med. 2014;11(2):374-385. DOI: 10.1111/jsm.12403

24. Magheli A, Busch J, Leva N, Schrader M, Deger S, Miller K, Lein M. Comparison of surgical technique (open vs. laparoscopic) on pathological and long term functional outcomes following radical prostatectomy. BMC Urol. 2014;14:18. DOI: 10.1186/1471-2490-14-18

25. Fode M, Sønksen J, Jakobsen H. Radical prostatectomy: initial experience with robot-assisted laparoscopic procedures at a large university hospital. Scand J Urol. 2014;48(3):252-258. DOI: 10.3109/21681805.2013.868514

26. Vickers AJ, Kent M, Mulhall J, Sandhu J. Counseling the post-radical prostatectomy patients about functional recovery: high predictiveness of current status. Urology. 2014;84(1):158-163. DOI: 10.1016/j.urology.2014.02.049

27. Akhvlediani N.D., Shvarts P.G., Kirichuk Y.V. Erectile dysfunction after nerve-sparing radical prostatectomy. Urologiia. 2017;(6):149-152. (In Russian). PMID: 29376613

28. Tavukçu HH, Aytac O, Atug F. Nerve-sparing techniques and results in robot-assisted radical prostatectomy. Investig Clin Urol. 2016;57(Suppl 2):S172-S184. DOI: 10.4111/icu.2016.57.S2.S172

29. Gandaglia G, Lista G, Fossati N, Suardi N, Gallina A, Moschini M, Bianchi L, Rossi MS, Schiavina R, Shariat SF, Salonia A, Montorsi F, Briganti A. Non-surgically related causes of erectile dysfunction after bilateral nerve-sparing radical prostatectomy. Prostate Cancer Prostatic Dis. 2016;19(2):185-190. DOI: 10.1038/pcan.2016.1

30. Wang X, Wu Y, Guo J, Chen H, Weng X, Liu X. Intrafascial nerve-sparing radical prostatectomy improves patients’ postoperative continence recovery and erectile function: A pooled analysis based on available literatures. Medicine (Baltimore). 2018;97(29):e11297. DOI: 10.1097/MD.0000000000011297

31. Rossi MS, Moschini M, Bianchi M, Gandaglia G, Fossati N, Dell’Oglio P, Schiavina R, Brunocilla E, Farina E, Picozzi M, Salonia A, Montorsi F, Briganti A. Erectile Function Recovery After Nerve-Sparing Radical Prostatectomy for Prostate Cancer: Is Back to Baseline Status Enough for Patient Satisfaction? J Sex Med. 2016;13(4):669-678. DOI: 10.1016/j.jsxm.2016.02.160

32. Kang SG, Shim JS, Onol F, Bhat KRS, Patel VR. Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome? Investig Clin Urol. 2020;61(1):1-10. DOI: 10.4111/icu.2020.61.1.1

33. Krishnan R, Katz D, Nelson CJ, Mulhall JP. Erectile function recovery in patients after non-nerve sparing radical prostatectomy. Andrology. 2014;2(6):951-954. DOI: 10.1111/andr.282

34. Becker A, Tennstedt P, Hansen J, Trinh QD, Kluth L, Atassi N, Schlomm T, Salomon G, Haese A, Budaeus L, Michl U, Heinzer H, Huland H, Graefen M, Steuber T. Functional and oncological outcomes of patients aged <50 years treated with radical prostatectomy for localised prostate cancer in a European population. BJU Int. 2014;114(1):38-45. DOI: 10.1111/bju.12407

35. Kim P, Clavijo RI. Management of male sexual dysfunction after cancer treatment. Urol Oncol. 2022;40(9):389-394. DOI: 10.1016/j.urolonc.2020.08.006

36. Yuan J, Zhang R, Yang Z, Lee J, Liu Y, Tian J, Qin X, Ren Z, Ding H, Chen Q, Mao C, Tang J. Comparative effectiveness and safety of oral phosphodiesterase type 5 inhibitors for erectile dysfunction: a systematic review and network meta-analysis. Eur Urol. 2013;63(5):902-12. DOI: 10.1016/j.eururo.2013.01.012

37. Goh HJ, Sung JM, Lee KH, Jo JK, Kim KN. Efficacy of phosphodiesterase type 5 inhibitors in patients with erectile dysfunction after nervesparing radical prostatectomy: a systematic review and meta-analysis. Transl Androl Urol. 2022;11(2):124-138. DOI: 10.21037/tau-21-881

38. Wang X, Wang X, Liu T, He Q, Wang Y, Zhang X. Systematic review and meta-analysis of the use of phosphodiesterase type 5 inhibitors for treatment of erectile dysfunction following bilateral nerve-sparing radical prostatectomy. PLoS One. 2014;9(3):e91327. DOI: 10.1371/journal.pone.0091327

39. Noh TI, Shim JS, Kang SG, Cheon J, Lee JG, Kang SH. Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study. Sex Med. 2022;10(3):100508. DOI: 10.1016/j.esxm.2022.100508

40. Lu X, Han H, Xing N, Tian L. [Efficacy of sildenafil citrate in men with erectile dysfunction following bilateral nerve-sparing radical prostatectomy: systematic review and meta-analysis]. Zhonghua Yi Xue Za Zhi. 2015;95(36):2964-2968. (In Chinese). PMID: 26814076.

41. Della Camera PA, Tellini R, Cito G, Rastrelli G, Maggi M, Chini T, Nunzio C, Altieri VM, Serni S, Gacci M, Natali A. Efficacy and safety of avanafil 200 mg versus sildenafil 100 mg in the treatment of erectile dysfunction after robot-assisted unilateral nerve-sparing prostatectomy: A prospective multicentre study. Urologia. 2020;87(1):23-28. DOI: 10.1177/0391560319867809

42. Limoncin E, Gravina GL, Corona G, Maggi M, Ciocca G, Lenzi A, Jannini EA. Erectile function recovery in men treated with phosphodiesterase type 5 inhibitor administration after bilateral nerve-sparing radical prostatectomy: a systematic review of placebo-controlled randomized trials with trial sequential analysis. Andrology. 2017;5(5):863-872. DOI: 10.1111/andr.12403

43. Welliver RC Jr, Mechlin C, Goodwin B, Alukal JP, McCullough AR. A pilot study to determine penile oxygen saturation before and after vacuum therapy in patients with erectile dysfunction after radical prostatectomy. J Sex Med. 2014;11(4):1071-1077. DOI: 10.1111/jsm.12445

44. Zhang M, Che JZ, Liu YD, Wang HX, Huang YP, Lv XG, Liu W, Lu MJ. A prospective randomized controlled study on scheduled PDE5i and vacuum erectile devices in the treatment of erectile dysfunction after nerve sparing prostatectomy. Asian J Androl. 2022;24(5):473-477. DOI: 10.4103/aja202189


Review

For citations:


Efremov M.E., Anosov A.D., Medvedev V.L., Kogan M.I. Sexuality of prostate cancer patients following radical prostatectomy. Urology Herald. 2025;13(2):92-102. (In Russ.) https://doi.org/10.21886/2308-6424-2025-13-2-92-102

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ISSN 2308-6424 (Online)