Research Urges Broader Sexual Health Support After Prostate Cancer

A recent UK-wide study provides a detailed examination of sexual dysfunction in prostate cancer survivors, describing a wide range of physical and psychological side effects reported across different stages of the disease and treatment approaches.

Published in Clinical Oncology, the study found that more than 98% of men treated for prostate cancer reported at least one new-onset sexual problem following diagnosis and treatment. While erectile dysfunction (ED) was the most frequently cited issue, many also experienced ejaculatory disturbances, penile changes, loss of sexual confidence, and reduced libido.

Researchers surveyed 654 men diagnosed with localized, locally advanced, or advanced prostate cancer. Treatment histories included radical prostatectomy (49.7%), radiotherapy (45.9%), and androgen deprivation therapy (ADT) (43.6%), among other approaches.

Although ED is a well-known complication of prostate cancer treatment, the study emphasized that sexual dysfunction extends beyond erection quality. More than three-quarters of participants reported diminished sexual confidence, 67% reported loss of sex drive, and 57% cited reduced self-esteem. The authors noted that these psychosexual challenges are common and often distressing.

Sexual activity remained important to most participants—78% indicated it was fairly or very important to them. Even among those with advanced prostate cancer, nearly half placed sexual problems among their top three current concerns. 

The study also found that men receiving a combination of radical prostatectomy, radiotherapy, and ADT were the most likely to report dysfunction across multiple domains. At the same time, more than half of those on active surveillance or watchful waiting who had not received active treatment reported at least one form of sexual dysfunction, most commonly ED and loss of sexual confidence.

Importantly, 78% of participants expressed a desire to discuss treatment-related sexual problems with a healthcare professional. Interest in support spanned both physical and psychosexual domains. While erectile dysfunction remained a top concern, many also wished to address loss of sexual confidence, self-esteem, and other quality-of-life issues.

The authors recommend a more comprehensive, biopsychosocial model of survivorship care. They emphasize the importance of addressing a wide range of physical and emotional impacts, not only focusing on erection recovery but also on sexual well-being, relationship dynamics, and self-image.

Treatment limitations were particularly notable in patients undergoing long-term ADT, for whom conventional erectile rehabilitation strategies such as PDE5 inhibitors may offer limited benefit. Motivation to pursue assistive therapies may also be reduced in the absence of sexual desire, highlighting the importance of customized care pathways for this group.

As survivorship increases and treatment outcomes improve, the study highlights the importance of addressing sexual health as part of quality-of-life outcomes in prostate cancer care. By listening to patients and expanding the scope of support, clinicians may better help individuals adapt and maintain satisfying sex lives, regardless of treatment history or disease progression.

Source

Kinnaird, W., P. Schartau, M. Kirby, V. Jenkins, S. Allen, and H. Payne. 2025. “Sexual Dysfunction in Prostate Cancer Patients according to Disease Stage and Treatment Modality.” Clinical Oncology 41 (March): 103801. https://doi.org/10.1016/j.clon.2025.103801.