Seksualiteit en androgeendeprivatietherapie bij de behandeling van prostaatkanker – een narratieve review

Androgen deprivation therapy (ADT) for prostate cancer has numerous deleterious effects on patient well-being and sexual functioning. ADT is associated with reduced penile contractility, a poor response to treatment with phosphodiesterase type 5 inhibitors (PDE5i), and a high risk of loss of sexual interest. Nonetheless, sexuality remains a crucial aspect of the quality of life for many patients and their partners, even at advanced ages and during ADT.

The treatment of ADT-induced sexual dysfunction is challenging to cover in a guideline. Treatment depends on the patient’s sexual functions prior to treatment, age, physical and mental health and desires of both patient and his partner.

The words ‘sex’ and ‘cancer’ evoke strong emotions and seem irreconcilable. Sex is indissoluble connected with life and procreation, whereas cancer is related to decay and death. But just for patients who face a life-threatening disease such as cancer, partner relationship, intimacy and sexual contact are very important for the quality of the years remaining. Therefore, the preservation of openness, intimacy, and non-penetrative sexual activities should always be encouraged to maintain patient’s self-esteem and relationship intimacy.

In clinical urological practice, it is important to pay attention to the impact of ADT on patients with prostate cancer and their partner’s personal lives. Accessible support needs to be provided to prevent depression and relationship crises. Initiating the dialogue on ‘sex’ during ADT, normalizing and naming of emotions related to the loss of masculine traits and sexual functions are crucial initial steps. Accurately informing patients about the expected effects of ADT on the physical and mental aspects of sexuality is also of great importance. Subsequently, facilitating easy access to psychological support by specialized nurses, urologists/andrologists, sexologists, or psychologists is the next step in providing assistance during this impactful treatment. Lastly, the importance of physical activity during ADT is significant and always needs to be stressed.

This article discusses the consequences of ADT on sexual functions and explores potential therapeutic and supportive treatment options.