Prevalence of sexual dysfunction among men with cancer before the initiation of systemic treatment.

Abstract

12049 Background: Sexual health significantly impacts the quality of life, yet its relationship with systemic cancer treatments in men remains underexplored, particularly outside prostate cancer-focused studies. In Brazil, the prevalence of moderate to complete sexual dysfunction among men is approximately 14.5%. This prospective cohort study conducted at a Brazilian Cancer Center evaluated the prevalence of sexual dysfunction before the initiation of systemic therapy in men diagnosed with solid tumors using the Male Sexual Quotient (MSQ) tool. Methods: Sexually active, treatment-naïve male patients with solid tumors were enrolled, excluding those with prostate cancer, active brain metastases, spinal compression, or prior pelvic irradiation/extensive pelvic surgery for rectal or bladder cancer. Baseline sexual function was assessed using the MSQ, which evaluates five domains: premature ejaculation, erectile dysfunction, hypoactive sexual desire, orgasm frequency, and dissatisfaction with sexual activity. An MSQ global score ≤60 defined moderate to complete sexual dysfunction. Hormonal profiles, including testosterone, FSH, and LH, were measured. The Hospital Anxiety and Depression Scale (HADS) was used to identify risks of anxiety or depression. All participants provided informed consent, and the local ethics committee approved the protocol. Results: Between October 2023 and December 2024, 73 male patients were recruited (median age 58 years, IQR 47.5–68.0); 78% were married, and 75% had an ECOG performance status of 0. At diagnosis, 34% presented with metastasis, including 19% with visceral involvement. Primary cancer sites included head and neck (25%), colorectal (19.1%), lung (15%), melanoma (8.2%), and kidney (8.2%). Treatment regimens comprised chemotherapy (76%), immunotherapy (31.5%), and targeted therapy (9.5%). Most patients (83%) had no risk of anxiety or depression per HADS, with one patient showing a high risk. Moderate to complete sexual dysfunction was observed in 22.2% of patients, higher than the general Brazilian male population. The most affected domains were hypoactive sexual desire, premature ejaculation, and erectile dysfunction. Despite these findings, median hormone levels were within the normal range: testosterone (356 ng/dL, IQR 300–468), FSH (64 mIU/mL, IQR 29–93), and LH (39 mIU/mL, IQR 28–52). Conclusions: The prevalence of moderate to complete sexual dysfunction was 22.2% in this cohort. This rate is higher than that observed in the general male population in Brazil. The evaluation of sexual quality of life in men with cancer undergoing systemic treatment is often overlooked. This data points to the need to develop new policies and studies to increase awareness about this critical issue.