Androgen deprivation therapy lowers satisfaction after penile prosthesis surgery

Prostate cancer is the most common malignancy among men, with over 160,000 new cases diagnosed annually in the United States. Although advances in surgery, radiotherapy, and hormone therapy have extended survival, these treatments often result in complications that impact quality of life. Erectile dysfunction, reduced libido, and changes in intimacy remain common and distressing, affecting both patients and their partners. Androgen deprivation therapy, in particular, has been shown to triple the risk of erectile dysfunction and significantly reduce sexual satisfaction. While penile prosthesis surgery provides a restorative option, little is known about its effectiveness in men previously treated with hormone therapy. Based on these challenges, there is a need for in-depth research on inflatable penile prosthesis (IPP) outcomes in the context of androgen deprivation therapy (ADT).

Researchers from the University of Texas McGovern Medical School, Hamad Medical Corporation, and MD Anderson Cancer Center published their study (DOI: 10.1002/uro2.116) on February 19, 2025, in UroPrecision. The research focused on whether androgen deprivation therapy (ADT)—commonly prescribed alongside surgery or radiotherapy for prostate cancer—affects patient satisfaction after inflatable penile prosthesis (IPP) surgery. By comparing satisfaction scores between men who had undergone ADT and those who had not, the study provides important new insights into how hormonal therapy shapes long-term sexual outcomes for prostate cancer survivors.

The team conducted a retrospective review of 529 cases treated between 2017 and 2022, identifying 96 prostate cancer survivors who had received IPP surgery and completed the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Patients were divided into two groups: those with prior ADT and those without. Findings showed that men with ADT reported significantly lower satisfaction scores (p = 0.0344). Independent of hormone therapy, men treated with radical prostatectomy generally reported higher satisfaction than those treated with radiation therapy. Coronary artery disease was also linked to lower satisfaction, suggesting comorbidities further influence outcomes. Researchers propose that ADT reduces satisfaction by suppressing testosterone, which not only targets prostate cancer cells but also weakens penile tissue, leading to atrophy and diminished elasticity. This physiological impact likely explains lower scores among ADT patients. Radiation therapy patients also had poorer results due to progressive vascular damage, while radical prostatectomy patients tended to benefit more from prosthesis surgery. These results underscore the importance of considering treatment history, comorbidities, and hormonal status when evaluating erectile dysfunction solutions.

Our study demonstrates that hormone therapy can leave a lasting imprint on sexual health, even after advanced treatments like penile prosthesis surgery. These findings are vital for clinicians when counseling prostate cancer patients, as they show that expectations and treatment choices must be carefully managed. While penile implants remain effective for restoring function, patients who have undergone hormonal therapy may require additional support and strategies to achieve satisfactory outcomes".

Dr. Kareim Khalafalla, senior author of the study

This study carries important implications for prostate cancer care. It highlights the need for pre-treatment counseling that fully explains the long-term effects of androgen deprivation therapy on sexual health and the effectiveness of prosthesis surgery. Integrating urologists, oncologists, and mental health professionals into patient care can ensure a more comprehensive approach to survivorship. As survival rates continue to improve, addressing quality-of-life concerns such as intimacy and sexual satisfaction becomes increasingly critical. Future research should focus on multicenter studies and explore strategies to counteract ADT-related dysfunction, paving the way for more personalized treatments that improve both physical and emotional recovery.