Erectile function and nocturnal penile tumescence in patients with prostate cancer undergoing luteinizing hormone‐releasing hormone agonist therapy

Abstract

Background: Luteinizing hormone-releasing hormone (LHRH) agonists have been widely used as effective agents in endocrine therapy for prostate cancer. Continuous administration of the drug results in profound suppression of testicular androgen production. However, the side effects on erectile function have not been fully investigated. Methods:We studied the influences of testosterone suppression on male sexual function and nocturnal penile tumescence in nine sexually active patients with prostate cancer who were treated with an LHRH agonist.Results: Following reduction of serum testosterone concentrations to a castration level by the administration of the LHRH agonist, sexual desire, sexual interest and sexual intercourse were totally annulled, with significant changes in frequency, magnitude, duration and rigidity of nocturnal erections observed in all patients.Conclusions: These results demonstrate that the LHRH agonist strongly suppresses erectile function and sexual activity. Taking into account the quality of sexual function for relatively young and sexually active patients and their partners, it is necessary to establish effective modalities that minimize the adverse effects on sexual function for the treatment of patients with prostate cancer.

Impact of androgen deprivation therapy on sexual function

“…In the study by Marumo et al 50 the maximal circumferential increase at the tip and base of the penile shaft during erection was significantly decreased by the administration of LHRH agonist (P,0.01). This is likely the result of smooth muscle loss and collagenization of the corporal tissue with resultant penile contraction.…”

“…49 In this study, 51% of men interested in sex before treatment reported 'no interest' after therapy and about 73% reported ceasing engaging in sexual activity after treatment, regardless of the type of ADT prescribed. 49 In the study by Marumo et al, 50 despite the total suppression of sexual activity induced by the LHRH agonist treatment, none of the nine previously active sexual patients presented serious complaints concerning ED and total suppression of sexual activity. This was explained by a concomitant selfreported decrease in sexual desire following therapy in all patients.…”

“…Marumo et al 50 observed in nine sexually active prostate cancer patients who underwent ADT with 3.75 mg of leuprorelin acetate every 4 weeks as monotherapy, that a reduction in serum testosterone concentrations to levels inferior to 10 ng dl 21 at 12 weeks, preceded total suppression of sexual activity (no intercourse for 12 weeks during treatment) in all patients. Nevertheless, in another study by Jannini et al, 51 performed on 83 patients with ED compared to 30 age-matched control patients, reduced total and free testosterone levels were seen in the former group (1162 nmol l 21 vs. 1865.5 nmol l 21 total testosterone and 56623 pmol l 21 vs. 79627 pmol l 21 free testosterone, respectively) (both P,0.001).…”

Andropause: Symptom Management for Prostate Cancer Patients Treated With Hormonal Ablation

“…An objective measurement of nocturnal penile tumescence prior to LHRH agonist therapy and 4 and 12 weeks after treatment showed a statistically significant decrease in frequency, magnitude, duration, and rigidity of nocturnal erections. The men in that study also reported decreased sexual desire, interest, and frequency of intercourse [141].…”

Preventing and treating the complications of hormone therapy

“…One study also showed that there is a decrease in frequency, degree of erection, length of erection, and rigidity in objective measurement of nocturnal penile tumescence before and after starting LHRH analog therapy. This study also showed a decrease in libido and frequency of intercourse [65]. Erectile dysfunction also is a common problem in men without prostate cancer.…”