How sexual interest shapes post-treatment bother in localized prostate cancer

In this interview from the 2026 American Urological Association Annual Meeting in Washington, DC, Bashir Al Hussein Al Awamlh, MD, MPH, discusses findings from a large international registry study evaluating how baseline sexual interest may influence sexual bother outcomes after treatment for localized prostate cancer.¹ Al Hussein is a urologic oncologist at Weill Cornell Medicine in New York, New York.

Al Hussein explained that sexual function remains one of the most important factors men consider when choosing among treatment options for localized prostate cancer, particularly when oncologic outcomes are comparable across modalities. He noted that treatment regret is often tied to inadequate counseling and unmet expectations surrounding urinary and sexual function. Although many prior studies have evaluated sexual function and sexual bother after treatment, he said relatively little attention has been paid to patients’ baseline interest in sex itself. The study was therefore designed to determine whether sexual interest independently influences how men perceive sexual function outcomes after treatment.

The analysis used data from the prospective True North Global Registry, which included 24,597 men with localized prostate cancer from 17 countries who underwent radical prostatectomy, external beam radiotherapy with androgen deprivation therapy, or active surveillance between 2016 and 2022. Baseline sexual interest was assessed using a patient-reported outcome measure from the EORTC-PR25 questionnaire, and outcomes were evaluated at 12 months.

Approximately 58.5% of patients reported being interested in sex at baseline. Among men with baseline sexual interest, rates of sexual bother increased from 13.8% at baseline to 48.3% at 12 months. Among men with lower sexual interest, sexual bother increased from 24.1% to 38.5% over the same period.

In adjusted analyses, men with lower baseline sexual interest were significantly less likely to report sexual bother one year after radical prostatectomy (adjusted OR [AOR], 0.61; 95% CI, 0.57 to 0.66) or radiation therapy with androgen deprivation therapy (AOR, 0.67; 95% CI, 0.45 to 1.0). However, an opposite trend was observed among patients managed with active surveillance, where lower sexual interest was associated with greater odds of sexual bother at 12 months (AOR, 1.57; 95% CI, 1.11 to 2.22). Al Hussein said these findings suggest that baseline sexual interest may play an important role in shaping patients’ perceptions of posttreatment sexual outcomes and could help inform individualized counseling and shared decision-making before treatment selection.

Reference

1. Al Hussein Al Awamlh B, Wilhalme H, Bailey A, Lee J, Belin T, Barocas D; The True NTH Global Registry. The role of sexual interest in sexual function outcomes in men undergoing treatment for localized prostate cancer: results from an international cohort. J Urol. 2026;215(5S):e1387. doi:10.1097/01.JU.0001191696.77479.2a.30