AccScience Publishing / ARNM / Online First / DOI: 10.36922/ARNM026300034
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ORIGINAL RESEARCH ARTICLE

Sexual quality of life after stereotactic body radiotherapy and androgen deprivation therapy for prostate cancer: A single-institution observational study

Trinanjan Basu1* ,  Jay Prakash Sahu1 ,  Shounak J. Kamat1 ,  Rohith R. Menon1 ,  Ghazala K. Roshan1 ,  Komal Parwani1 ,  Parv Modi1
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1 HealthCare Global Cancer Center, Mumbai, Maharashtra , India
ARNM, 026300034 https://doi.org/10.36922/ARNM026300034
Received: 22 July 2026 | Revised: 24 September 2026 | Accepted: 9 October 2026 | Published online: 22 October 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Sexual quality of life (QOL) of prostate cancer (PCa) patients is severely impacted following curative treatment, yet remains infrequently discussed. The objective was to report the sexual QOL outcome of PCa patients treated by stereotactic body radiotherapy (SBRT) and androgen deprivation therapy (ADT). A total of 53 PCa patients across National Comprehensive Cancer Network risk categories with at least six months of follow-up were included in this study. Sexual symptom scores were assessed before SBRT and at 6, 12, 18, 24, and 36 months after treatment using the Expanded Prostate Cancer Index Composite for Clinical Practice questionnaire. The mean dose to the penile bulb (Dmean) and dose received by the bilateral neurovascular bundle (NVB) were documented. The mean sexual symptoms score was 5.06 pre-SBRT, increasing to 8.2 at 18 months post-SBRT and subsequently decreasing to 7.4 and 6.25 at 24 and 36 months post-SBRT, respectively, suggesting a potential recovery of sexual QOL beyond 2 years. The median Dmean to the penile bulb was 20.6 Gy, and median V34.4, V32, and V28 of the NVB were 88.4%, 96.7%, and 99.9%, respectively. SBRT combined with ADT was associated with a low observed frequency of biochemical failure and a decline in sexual QOL in this cohort. Larger prospective studies incorporating NVB-sparing strategies are needed to clarify the determinants of post-treatment sexual QOL.

Graphical abstract
Keywords
Prostate cancer
Stereotactic body radiotherapy
Sexual quality of life
Neurovascular bundles
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
References
  1. Wiegner EA, King CR. Sexual function after stereotactic body radiotherapy for prostate cancer: results of a prospective clinical trial. Int J Radiat Oncol Biol Phys. 2010;78(2):442-448. doi: 10.1016/j.ijrobp.2009.07.1748
  2. Robinson JW, Moritz S, Fung T. Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma. Int J Radiat Oncol Biol Phys. 2002;54(4):1063-1068. doi: 10.1016/S0360-3016(02)03030-4
  3. Latorzeff I, Mazurier J, Boutry C, Dudouet P, Richaud P, de Crevoisier R. Apports de la radiothérapie avec modulation d’intensité guidée par l’image dans les cancers prostatiques [Benefit of intensity modulated and image-guided radiotherapy in prostate cancer]. Cancer Radiother. 2010;14(6-7):479-487. [In French] doi: 10.1016/j.canrad.2010.06.013
  4. Stuk J, Vanasek J, Odrazka K, et al. Image-guided radiation therapy produces lower acute and chronic gastrointestinal and genitourinary toxicity in prostate cancer patients. J BUON. 2021;26(3):940-948.
  5. Hall WA, Deshmukh S, Bruner DW, et al. Quality of Life Implications of Dose-Escalated External Beam Radiation for Localized Prostate Cancer: Results of a Prospective Randomized Phase 3 Clinical Trial, NRG/RTOG 0126. Int J Radiat Oncol Biol Phys. 2022;112(1):83-92. doi: 10.1016/j.ijrobp.2021.07.004
  6. Beckendorf V, Guerif S, Le Prisé E, et al. 70 Gy versus 80 Gy in localized prostate cancer: 5-year results of GETUG 06 randomized trial. Int J Radiat Oncol Biol Phys. 2011;80(4):1056-1063. doi: 10.1016/j.ijrobp.2010.03.049
  7. Loi M, Wortel RC, Francolini G, Incrocci L. Sexual Function in Patients Treated With Stereotactic Radiotherapy For Prostate Cancer: A Systematic Review of the Current Evidence. J Sex Med. 2019;16(9):1409-1420. doi: 10.1016/j.jsxm.2019.05.019
  8. Tree AC, Ostler P, van der Voet H, et al. Intensity-modulated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): 2-year toxicity results from an open-label, randomised, phase 3, non-inferiority trial. Lancet Oncol. 2022;23(10):1308-1320. doi: 10.1016/S1470-2045(22)00517-4
  9. Chang P, Szymanski KM, Dunn RL, et al. Expanded Prostate Cancer Index Composite for Clinical Practice: development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer. J Urol. 2011;186(3):865-872. doi: 10.1016/j.juro.2011.04.085
  10. Salembier C, Villeirs G, De Bari B, et al. ESTRO ACROP consensus guideline on CT- and MRI-based target volume delineation for primary radiation therapy of localized prostate cancer. Radiother Oncol. 2018;127(1):49-61. doi: 10.1016/j.radonc.2018.01.014
  11. Murthy V, Mallick I, Gavarraju A, et al. Study protocol of a randomised controlled trial of prostate radiotherapy in high-risk and node-positive disease comparing moderate and extreme hypofractionation (PRIME TRIAL). BMJ Open. 2020;10(2):e034623. doi: 10.1136/bmjopen-2019-034623
  12. Leiker AJ, Hassan Rezaeian N, Laine AM, et al. Prostate Cancer Neurovascular Element Sparing with Stereotactic Ablative Radiation Therapy (SAbR): A Pilot Dosimetric Study for the POTEN-C Trial. International Journal of Radiation Oncology Biology Physics. 2018;102(3):e125-e125. doi: 10.1016/j.ijrobp.2018.07.335
  13. Arif R, Hami H, Sennani S, et al. Long-term impacts of prostate cancer treatments on sexual function and psychological well-being: A comprehensive narrative review. Eur Psychiatry. 2025;68(S1):S877. doi: 10.1192/j.eurpsy.2025.1779
  14. Vale J. Erectile dysfunction following radical therapy for prostate cancer. Radiother Oncol. 2000;57(3):301-305. doi: 10.1016/s0167-8140(00)00293-0
  15. Potters L, Torre T, Fearn PA, Leibel SA, Kattan MW. Potency after permanent prostate brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2001;50(5):1235-1242. doi: 10.1016/s0360-3016(01)01578-4
  16. Siegel T, Moul JW, Spevak M, Alvord WG, Costabile RA. The development of erectile dysfunction in men treated for prostate cancer. J Urol. 2001;165(2):430-435. doi: 10.1097/00005392-200102000-00019
  17. Potosky AL, Legler J, Albertsen PC, et al. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study. J Natl Cancer Inst. 2000;92(19):1582-1592. doi: 10.1093/jnci/92.19.1582
  18. Alemozaffar M, Regan MM, Cooperberg MR, et al. Prediction of erectile function following treatment for prostate cancer. JAMA. 2011;306(11):1205-1214. doi: 10.1001/jama.2011.1333
  19. Dess RT, Hartman HE, Aghdam N, et al. Erectile function after stereotactic body radiotherapy for localized prostate cancer. BJU Int. 2018;121(1):61-68. doi: 10.1111/bju.13962
  20. Rucinska M, Kieszkowska-Grudny A. Quality of Life and Sexual Activity after Stereotactic Hypofractionated Radiotherapy of Prostate Cancer Patients. J Integr Oncol. 2016;5(3). doi: 10.4172/2329-6771.1000173
  21. Szymanski KM, Wei JT, Dunn RL, Sanda MG. Development and validation of an abbreviated version of the expanded prostate cancer index composite instrument for measuring health-related quality of life among prostate cancer survivors. Urology. 2010;76(5):1245-1250. doi: 10.1016/j.urology.2010.01.027
  22. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319-326. doi: 10.1038/sj.ijir.3900472
  23. Katz AJ, Kang J. Quality of Life and Toxicity after SBRT for Organ-Confined Prostate Cancer, a 7-Year Study. Front Oncol. 2014;4:301. doi: 10.3389/fonc.2014.00301
  24. Morris BA, Holmes EE, Anger NJ, et al. Toxicity and patient-reported quality-of-life outcomes after prostate stereotactic body radiation therapy with focal boost to magnetic resonance imaging-identified prostate cancer lesions: results of a phase 2 trial. Int J Radiat Oncol Biol Phys. 2023;117(3):613-623. doi: 10.1016/j.ijrobp.2023.05.004
  25. McDonald AM, Baker CB, Shekar K, et al. Reduced Radiation Tolerance of Penile Structures Associated With Dose-escalated Hypofractionated Prostate Radiotherapy. Urology. 2014;84(6):1383-1388. doi: 10.1016/j.urology.2014.07.060
  26. Selek U, Cheung R, Lii M, et al. Erectile dysfunction and radiation dose to penile base structures: a lack of correlation. Int J Radiat Oncol Biol Phys. 2004;59(4):1039-1046. doi: 10.1016/j.ijrobp.2003.12.028
  27. van der Wielen GJ, Hoogeman MS, Dohle GR, van Putten WL, Incrocci L. Dose-volume parameters of the corpora cavernosa do not correlate with erectile dysfunction after external beam radiotherapy for prostate cancer: results from a dose-escalation trial. Int J Radiat Oncol Biol Phys. 2008;71(3):795-800. doi: 10.1016/j.ijrobp.2007.10.052
  28. Mangar SA, Sydes MR, Tucker HL, et al. Evaluating the relationship between erectile dysfunction and dose received by the penile bulb: using data from a randomised controlled trial of conformal radiotherapy in prostate cancer (MRC RT01, ISRCTN47772397). Radiother Oncol. 2006;80(3):355-362. doi: 10.1016/j.radonc.2006.07.037
  29. Rasmusson E, Gunnlaugsson A, Wieslander E, et al. Erectile Dysfunction and Absorbed Dose to Penile Base Structures in a Randomized Trial Comparing Ultrahypofractionated and Conventionally Fractionated Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys. 2020;107(1):143-151. doi: 10.1016/j.ijrobp.2020.01.022
  30. Thor M, Olsson CE, Oh JH, et al. Radiation Dose to the Penile Structures and Patient-Reported Sexual Dysfunction in Long-Term Prostate Cancer Survivors. J Sex Med. 2015;12(12):2388-2397. doi: 10.1111/jsm.13031
  31. Obayomi-Davies O, Chen LN, Bhagat A, et al. Potency preservation following stereotactic body radiation therapy for prostate cancer. Radiat Oncol. 2013;8(1):256.. doi: 10.1186/1748-717X-8-256
  32. Achard V, Zilli T, Lamanna G, et al. Urethra-Sparing Prostate Cancer Stereotactic Body Radiation Therapy: Sexual Function and Radiation Dose to the Penile Bulb, the Crura, and the Internal Pudendal Arteries From a Randomized Phase 2 Trial. Int J Radiat Oncol Biol Phys. 2024;119(4):1137-1146. doi: 10.1016/j.ijrobp.2023.12.037
  33. Hwang ME, Mayeda M, Shaish H, et al. Dosimetric feasibility of neurovascular bundle-sparing stereotactic body radiotherapy with periprostatic hydrogel spacer for localized prostate cancer to preserve erectile function. Br J Radiol. 2021;94(1119):20200433. doi: 10.1259/bjr.20200433
  34. Teunissen FR, van der Voort van Zyp JRN, Verkooijen HM, Wortel RC. Neurovascular-Sparing MR-Guided Adaptive Radiotherapy in Prostate Cancer; Defining the Potential Population for Erectile Function-Sparing Treatment. J Sex Med. 2022;19(7):1196-1200. doi: 10.1016/j.jsxm.2022.04.006
  35. Teunissen FR, Wortel RC, Hes J, et al. Adaptive magnetic resonance-guided neurovascular-sparing radiotherapy for preservation of erectile function in prostate cancer patients. Phys Imaging Radiat Oncol. 2021;20:5-10. doi: 10.1016/j.phro.2021.09.002
  36. Donovan KA, Gonzalez BD, Nelson AM, Fishman MN, Zachariah B, Jacobsen PB. Effect of androgen deprivation therapy on sexual function and bother in men with prostate cancer: A controlled comparison. Psycho-Oncol. 2018;27(1):316-324. doi: 10.1002/pon.4463
  37. Saxby H, Boussios S, Mikropoulos C. Androgen Receptor Gene Pathway Upregulation and Radiation Resistance in Oligometastatic Prostate Cancer. Int J Mol Sci. 2022;23(9):4786. doi: 10.3390/ijms23094786
  38. van As N, Griffin C, Tree A, et al. Phase 3 Trial of Stereotactic Body Radiotherapy in Localized Prostate Cancer. N Engl J Med. 2024;391(15):1413-1425. doi: 10.1056/NEJMoa2403365
  39. van As N, Yasar B, Griffin C, et al. Radical Prostatectomy Versus Stereotactic Radiotherapy for Clinically Localised Prostate Cancer: Results of the PACE-A Randomised Trial. Eur Urol. 2024;86(6):566-576. doi: 10.1016/j.eururo.2024.08.030
  40. Poon DMC, Wong K, Lam D, et al. Acute Toxicity and Quality of Life With Stereotactic Body Radiation Therapy Versus Conventional Fractionated Intensity Modulated Radiation Therapy to the Prostate and Pelvis in High-Risk Prostate Cancer: A Randomized Phase 2 Trial. Int J Radiat Oncol Biol Phys. 2026. doi: 10.1016/j.ijrobp.2026.06.3080
  41. Martinez C, Cury F, Duclos M, et al. Cumulative incidence of toxicity between 2 and 5 years following SBRT to the prostate and pelvis nodes in patients with high-risk prostate cancer. Pract Radiat Oncol. 2026. doi: 10.1016/j.prro.2026.06.015
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Advances in Radiotherapy & Nuclear Medicine, Electronic ISSN: 2972-4392 Print ISSN: 3060-8554, Published by AccScience Publishing
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