Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. Anorgasmia (AO) is characterized as the absence of orgasm. Etiologies of DO/AO include medication-induced, psychogenic, endocrine, and genitopelvic dysesthesia. Given the multifactorial complex nature of this disorder, a thorough history and physical examination represent the most critical components of patient evaluation in the clinical setting. Treating DO/AO can be challenging due to the lack of standardized FDA-approved pharmacotherapies. There is no standardized treatment plan for DO/AO, though common treatments plans are often multidisciplinary and may include adjustment of offending medications and sex therapy. In this review, we summarize the etiology, diagnosis, and treatment of DO/AO.

As the indications for the use of immunotherapy in genitourinary malignancies expand, its role in combination with standard or conventional therapies has become the subject of contemporary studies. Radiotherapy has multiple immunomodulating effects on anti-tumor immune response, which highlights potential synergistic role with immunotherapy agents. We sought to review the body of published data studying the combination of immunotherapy and radiotherapy as well as the rationale for combination therapy. Trial information and primary articles were obtained using the following terms “immunotherapy”, “radiotherapy”, “prostate cancer”, and “bladder cancer.” All articles and trials were screened to ensure they included combination radiotherapy and immunotherapy. The effects of radiation on the immune system, including both immunogenic and immunosuppressive effects, have been reported. There is a potential for combinatorial or synergistic effects between radiation therapy and immunotherapy in treating bladder and prostate cancers. However, results from ongoing and future clinical trials are needed to best integrate immunotherapy into current standard of care treatments for GU cancers.

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Overall, of 139 patients who met our criteria, 29% received novel secondary hormone therapy. Compliance with NCCN Category 1 recommendations in terms of novel secondary hormone therapy was 68% overall, including 62% for mCSPC patients, 83% for M0 CRPC patients, and 70% for M1 CRPC. Compliance with Category 2A recommendations for adding novel hormone therapy was 16% overall. When we examined the compliance for individual practitioners, the compliance for the 5 highest-volume urologists ranged from 26-50% overall and 45-100% for Category 1 recommendations.CONCLUSIONS: Our findings demonstrate relatively low compliance with Category 1 and 2A recommendations for adding novel secondary hormone therapy in patients with advanced prostate cancer. There is an opportunity to immediately optimize treatment for these patients and future patients with quality improvement initiatives.

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