Sexual function in a nationwide cohort of 2260 testicular cancer survivors after 17 years follow-up

PURPOSE: Evidence on the long-term impact of testicular cancer (TC) treatment on sexual function is not clear. The aim was to estimate the effect of TC treatment on the risk of sexual dysfunction in long-term testicular cancer survivors.

MATERIALS AND METHODS: We conducted a cross-sectional study of 2260 long-term TC survivors (median follow-up 17 years (IQR 12-24 years)) treated with orchiectomy alone (surveillance) (n=1098), bleomycin, etoposide, cisplatin (BEP) (BEP alone or BEP with post chemotherapy retroperitoneal surgery (n=788), abdominal radiotherapy (RT) (n=300), and more than one line of treatment (MTOL) (n=74). Sexual function was evaluated by the International Index of Erectile Function questionnaire (IIEF-15). Results were compared between treatment groups using logistic regression analysis with the results on each of the 5 dimensions of IIEF-15 as outcome, and treatment as exposure using surveillance as reference.

RESULTS: The risk of erectile dysfunction was increased in all treatment groups when compared to surveillance: (BEP alone: Odds ratio (OR) = 1.5 (95% confidence interval (CI): 1.0-2.1), (p<0.05), BEP with post chemotherapy surgery, OR = 2.1 (95% CI: 1.4-3.4), (p<0.005), RT: OR = 1.7 (95% CI: 1.1-2.5), (p<0.05) and MTOL: OR = 3.2 (95% CI: 1.6-6.3), (p<0.005). Orgasmic dysfunction was associated with RT, BEP with post chemotherapy surgery and MTOL.

CONCLUSIONS: Treatment with BEP, RT and MTOL increases the risk of erectile dysfunction in long-term TC-survivors compared to surveillance. Patients should be informed about this as part of the information on treatment related late effects.