ESTRO 2024 - Abstract Book

S2555

Clinical - Urology

ESTRO 2024

1 University College London, Medical Physics and Biomedical Engineering, London, United Kingdom. 2 The Clatterbridge Cancer Centre NHS Foundation Trust, Radiotherapy, Liverpool, United Kingdom. 3 Trends in Urology & Men’s Health, Editor, London, United Kingdom. 4 University College London, Primary Care and Population Health, London, United Kingdom. 5 University of Sussex, Sussex Health Outcomes Research & Education in Cancer, Brighton, United Kingdom

Purpose/Objective:

Strategies for managing sexual dysfunction (SD) after prostate cancer (PCa) treatment have historically focused on men with early-stage disease. There has been little guidance for men with advanced PCa, whose disease management involves permanent androgen deprivation therapy (ADT). Castration-levels of testosterone make rehabilitation more challenging and problems are compounded by concurrent/previous therapies including radiotherapy (RT), prostatectomy, androgen receptor targeted agents, chemotherapy and radionuclides. This systematic review is the first to evaluate the efficacy of SD interventions in the context of advanced disease.

Material/Methods:

A systematic review was carried out according to PRISMA guidelines with searches conducted in MEDLINE, CINAHL, Cochrane and EMBASE databases. The last search was conducted on September 18, 2023. Randomised controlled trials (RCTs) assessing mechanical, pharmaceutical, lifestyle, and psycho-educational interventions were included. Screening, data extraction and quality assessment were carried out by two authors. Narrative synthesis was used as meta-analysis was not possible due to heterogeneity of outcomes.

Results:

Searches identified 6,975 articles which were screened according to inclusion/exclusion criteria. This resulted in 25 RCTs being included in the analysis (Figure 1). All study participants were undergoing ADT, but some had also undergone, RT, proton beam therapy, brachytherapy, radical prostatectomy, chemotherapy, watchful waiting and active surveillance. Overall, the quality of evidence was low. The risk of bias in the studies was generally high or unclear, primarily due to performance bias and small sample size.

The interventions were grouped into five categories and the results are summarised in Table 1:

Psycho-educational : Eight trials 18-25 examined psychological and educational interventions.

Two studies 20,21 investigated interventions encouraging intimacy and communication between couples. No improvement in relationship satisfaction was seen among men although partners in one study reported greater short-term relationship satisfaction. Three studies 22,24,25 investigated educating participants in side effect management via face-to-face sessions, web based support, literature, videos and personalised plans. No intervention led to improved sexual function. Two reported higher rates of sexual activity among couples in the intervention arms.