Restoring sexual health extends beyond the normalization of testosterone levels following cessation of ADT, with a significant time lag between testosterone recovery and improvement of erectile function and sexual QOL after brachytherapy.
Key Findings
Results
SHIM scores and sexual function domain of EPIC scores deteriorated significantly up to 36 months post-treatment in patients receiving brachytherapy with neoadjuvant ADT compared to those without.
Study included 139 participants, of whom 41 received neoadjuvant ADT (median duration 4 months, maximum 6 months)
Brachytherapy was performed at a single institution from 2010 to 2018
Sexual Health Inventory for Men (SHIM) scores were used to assess erectile function
The expanded prostate cancer index composite (EPIC) sexual function domain was used to assess sexual QOL
Deterioration in the ADT group persisted significantly through 36 months post-treatment
Results
Total testosterone levels in the brachytherapy with neoadjuvant ADT group gradually recovered post-treatment and were similar to those in the brachytherapy without neoadjuvant ADT group after 12 months.
Testosterone recovery occurred within approximately 12 months after treatment cessation
Despite testosterone normalization at 12 months, sexual function and sexual QOL remained impaired beyond this point
This finding demonstrates a time lag between hormonal recovery and functional/QOL recovery
Serum total testosterone levels were measured chronologically in both groups
Results
Neoadjuvant ADT and a lower pre-treatment SHIM score were identified as risk factors for severe erectile dysfunction 12 months after treatment.
Both neoadjuvant ADT use and lower baseline SHIM score were independent risk factors for severe erectile dysfunction at 12 months post-treatment
Pre-treatment erectile function status (baseline SHIM score) was a significant predictor of post-treatment outcome
This finding suggests that patient selection and baseline sexual health assessment are relevant to counseling
Results
A significant decline was observed in the sexual bother domain of EPIC scores in patients without neoadjuvant ADT up to 6 months post-treatment, relative to those with neoadjuvant ADT.
Patients who did not receive ADT experienced greater sexual bother (distress) early after brachytherapy compared to those who received ADT
The authors hypothesized that ADT-treated patients had diminished sexual distress attributable to fewer opportunities for sexual engagement than their untreated counterparts
This suggests ADT may temporarily suppress awareness of sexual dysfunction by reducing sexual desire and activity
The difference in sexual bother was significant through 6 months post-treatment
Discussion
Short-term neoadjuvant ADT of up to 6 months duration was associated with persistent sexual dysfunction despite eventual normalization of testosterone levels.
ADT duration in the study was short-term, defined as ≤6 months, with a median of 4 months
Persistent sexual dysfunction was observed even after testosterone levels returned to levels comparable to those in the non-ADT group
The authors concluded that restoring sexual health extends beyond the normalization of testosterone levels following cessation of ADT
This indicates that mechanisms other than testosterone suppression contribute to sustained erectile dysfunction after ADT
What This Means
This research suggests that when men with prostate cancer receive a short course of hormone-blocking therapy (androgen deprivation therapy, or ADT) before brachytherapy (a type of internal radiation treatment), their sexual health is significantly worse for up to three years after treatment compared to men who had brachytherapy alone. The study followed 139 men treated between 2010 and 2018, 41 of whom received up to 6 months of hormone therapy before their radiation treatment. While the hormone levels (testosterone) of men who received ADT recovered to normal within about 12 months, their erectile function and sexual quality of life continued to lag behind those who never received the hormone therapy—suggesting that testosterone recovery alone does not mean sexual function has recovered.
Interestingly, the research also found that men who did not receive hormone therapy reported more sexual distress (bother) in the first 6 months after treatment. The authors suggest this is because hormone therapy reduces sexual desire and activity, so men on ADT are less aware of or bothered by their sexual difficulties early on—but this apparent short-term benefit masks a longer period of sexual impairment that follows. Having a lower level of sexual function before treatment and having received ADT were both identified as risk factors for severe erectile dysfunction one year after treatment.
This research suggests that doctors and patients should be aware that the sexual side effects of even short-term hormone therapy can persist well beyond the point when hormone levels appear to have normalized. Understanding these longer-term effects on sexual quality of life can help guide conversations between patients and their doctors about treatment choices, realistic expectations, and the potential need for ongoing support or treatment for sexual health after prostate cancer therapy.
Onishi K, Nakai Y, Maesaka F, Tomizawa M, Shimizu T, Hori S, et al.. (2026). Impact of androgen deprivation therapy on sexual health in patients who underwent brachytherapy for prostate cancer.. Andrology. https://doi.org/10.1111/andr.70066