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Impact of Androgen Deprivation Therapy on Men’s Sexual Health

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Cancer and Sexual Health

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

The importance of androgens in the maintenance of homeostasis in a male has been well established. Even in the earliest stages of embryological development, androgens play a vital role in sex differentiation. This is most evident in patients who lack androgen receptors or have decreased androgen sensitization, leading to sexual dimorphism [1]. The association of aging with a decline in sexual health has been acknowledged since the nineteenth century, when Brown Séquard began to inject himself with a mixture of dog and guinea pig testicular extracts to ­“rejuvenate himself” [2]. He claimed this mixture would improve his physique as well as his mental capacity. This background generated enormous interest in finding the “fountain of youth.” It was not until 1935 that Butenandt, Ruzicka, and Gyula successfully and independently synthesized a hormone named testosterone, for which Butenandt and Ruzicka received the Nobel Prize of Medicine in 1939 [3]. Public interest grew in the applications of this new ­“silver bullet” for a wide range of ailments, ranging from sexual dysfunction to age reversion. Around the same time, an astute clinician/researcher, Charles B. Huggins, reported that “prostatic epithelium undergoes atrophy when androgen hormones are greatly reduced in amount.” He then concluded that “significant improvements should occur in the clinical condition of patients with far advanced prostate cancer subjected to castration” [4].

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References

  1. Wiener JS, Teague JL, Roth DR, et al. Molecular biology and function of the androgen receptor in genital development. J Urol. 1997;157:1377–86.

    Article  PubMed  CAS  Google Scholar 

  2. Brown-Séquard CE. Note on the effects produced on man by subcutaneous injections of a liquid obtained from the testicles of animals. Lancet. 1889;2:105–7.

    Article  Google Scholar 

  3. The Nobel Prize in Chemistry 1939 and Medicine 1966. http://nobelprize.org/nobel_prizes/chemistry/laureates. Accessed August 26, 2009.

  4. Huggins C, Hodges CV. Studies on prostatic cancer – the effect of castration, of estrogen, and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate 1941. J Urol. 2002;167(2 Pt 2):948–51.

    Article  PubMed  CAS  Google Scholar 

  5. Stanford JL, Stephenson RA, Coyle LM, et al. Prostate Cancer Trends 1973-1995, SEER Program, National Cancer Institute. NIH Pub. No. 99-4543. Bethesda, MD, 1999.

    Google Scholar 

  6. Lubahn DB, Brown TR, Simental JA, et al. Sequence of the intron/exon junctions of the coding region of the human androgen receptor gene and identification of a point mutation in a family with complete androgen insensitivity. Proc Natl Acad Sci USA. 1989;86:9534–8.

    Article  PubMed  CAS  Google Scholar 

  7. He WW, Kumar MV, Tindall DJ. A frame-shift mutation in the androgen receptor gene causes complete androgen insensitivity in the testicular-feminized mouse. Nucleic Acids Res. 1991;19:2373–8.

    Article  PubMed  CAS  Google Scholar 

  8. Russell DW, Wilson JD. Steroid 5 alpha-reductase: two genes/two enzymes. Annu Rev Biochem. 1994;63:25–61.

    Article  PubMed  CAS  Google Scholar 

  9. Hayward SW, Baskin LS, Haughney PC, et al. Epithelial development in the rat ventral prostate, anterior prostate and seminal vesicle. Acta Anat. 1996;155:81–93.

    Article  PubMed  CAS  Google Scholar 

  10. Vom Saal FS, Timms BG, Montano MM, et al. Prostate enlargement in mice due to fetal exposure to low doses of estradiol or diethylstilbestrol and opposite effects at high doses. Proc Natl Acad Sci USA. 1997;94:2056–61.

    Article  PubMed  CAS  Google Scholar 

  11. Podlasek CA, Duboule D, Bushman W. Male accessory sex organ morphogenesis is altered by loss of function of Hoxd-13. Dev Dyn. 1997;208:454–65.

    Article  PubMed  CAS  Google Scholar 

  12. Cancilla B, Jarred RA, Wang H, et al. Regulation of prostate branching morphogenesis by activin A and follistatin. Dev Biol. 2001;237:145–58.

    Article  PubMed  CAS  Google Scholar 

  13. Ruan W, Powell-Braxton L, Kopchick JJ, et al. Evidence that insulin-like growth factor I and growth hormone are required for prostate gland development. Endocrinology. 1999;140:1984–9.

    Article  PubMed  CAS  Google Scholar 

  14. Elfman F, Bok R, Conn M, et al. Urokinase plasminogen activator amino-terminal peptides inhibit development of the rat ventral prostate. Differentiation. 2001;69:108–20.

    Article  PubMed  CAS  Google Scholar 

  15. Metzdorff SB, Dalgaard M, Christensen S, et al. Dysgenesis and histological changes of genitals and perturbations of gene expression in male rats after in utero exposure to antiandrogen mixtures. Toxicol Sci. 2007;98(1):87–98.

    Article  PubMed  CAS  Google Scholar 

  16. Zitzmann M, Faber S, Nieschlaq E. Association of specific symptoms and metabolic risks with serum testosterone in older men. J Clin Endocrinol Metab. 2006;91(11):4335–43.

    Article  PubMed  CAS  Google Scholar 

  17. Schlegel PN, Hardy MP, Goldstein M. Male reproductive physiology. In: Wein AJ, Kavoussi LR, Novick AC, et al., editors. Campbell-Walsh urology. 9th ed. Philadelphia, PA: Saunders Elsevier; 2007. p. 577–608.

    Google Scholar 

  18. Guay AT. Testosterone and erectile physiology. Aging Male. 2006;9:201.

    Article  PubMed  CAS  Google Scholar 

  19. Teloken PE, Ohebshalom M, Mohideen N, et al. Analysis of the impact of androgen deprivation therapy on sildenafil citrate response following radiation therapy for prostate cancer. J Urol. 2007;178:2521.

    Article  PubMed  Google Scholar 

  20. Mulhall J, Ahmed A, Parker M, et al. The hemodynamics of erectile dysfunction following external beam radiation for prostate cancer. J Sex Med. 2005;2:432.

    Article  PubMed  Google Scholar 

  21. Foresta C, Caretta N, Rosatto M, et al. Role of androgens in erectile function. J Urol. 2004;171:2358.

    Article  PubMed  CAS  Google Scholar 

  22. Aversa A, Isidori AM, De Martino MU, et al. Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilatation in men with erectile dysfunction. Clin Endocrinol (Oxf). 2000;53:517.

    Article  CAS  Google Scholar 

  23. Saad F, Grahl AS, Aversa A, et al. Effects of testosterone on erectile function: implications for the therapy of erectile dysfunction. BJU Int. 2007;99:988.

    Article  PubMed  CAS  Google Scholar 

  24. Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction. In: Wein AJ, Kavoussi LR, Novick AC, et al., editors. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders Elsevier; 2007. p. 718–49.

    Google Scholar 

  25. Gonzales GF. Test for androgen activity at the male reproductive tract in infertile men. Arch Androl. 1994;32:235–42.

    Article  PubMed  CAS  Google Scholar 

  26. Morales A, Morley J, Heaton JP. Molecular biology, endocrinology, and physiology of the prostate and seminal vesicles. In: Wein AJ, Kavoussi LR, Novick AC, et al., editors. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders Elsevier; 2007. p. 2677–726.

    Google Scholar 

  27. Cohen PG. The association of premature ejaculation and hypogonadotropic hypogonadism. J Sex Marital Ther. 1997;23:208–11.

    PubMed  CAS  Google Scholar 

  28. Corona G, Jannini EA, Mannucci E, et al. Different testosterone levels are associated with ejaculatory dysfunction. J Sex Med. 2008;5:1991–8.

    Article  PubMed  CAS  Google Scholar 

  29. Corona G, Mannucci E, Petrone L, et al. Androtest: a structured interview for the screening of hypogonadism in patients with sexual dysfunction. J Sex Med. 2006;3:706–15.

    Article  PubMed  Google Scholar 

  30. Quigley CA, De Bellis A, Marschke KB, et al. Androgen receptor defects: historical, clinical and molecular perspectives. Endocr Rev. 1995;16:271–321.

    PubMed  CAS  Google Scholar 

  31. Herr HW, Kornblith AB, Ofman U. A comparison of quality of life of patients with metastatic prostate cancer who received or did not receive hormonal therapy. Cancer. 1993;71:1143–50.

    Article  PubMed  CAS  Google Scholar 

  32. Cassileth BR, Soloway MS, Vogelzang NJ, et al. Quality of life and psychosocial status in stage D prostate cancer: Zoladex Prostate Cancer Study Group. Qual Life Res. 1992;1:323–9.

    Article  PubMed  CAS  Google Scholar 

  33. Litwin MS, Shpall AI, Dorey F, et al. Quality-of-life outcomes in long-term survivors of advanced prostate cancer. Am J Clin Oncol. 1998;21:327–32.

    Article  PubMed  CAS  Google Scholar 

  34. Potosky AL, Knopf K, Clegg LX, et al. Quality-of-life outcomes after primary androgen deprivation therapy: results from the Prostate Cancer Outcomes Study. J Clin Oncol. 2001;19:3750–7.

    PubMed  CAS  Google Scholar 

  35. Potosky AL, Reeve BB, Clegg LX, et al. Quality of life following localized prostate cancer treated initially with androgen deprivation therapy or no therapy. J Natl Cancer Inst. 2002;94:430–7.

    PubMed  Google Scholar 

  36. DiBlasio CJ, Malcolm JB, Derweesh IH, et al. Patterns of sexual and erectile dysfunction and response to treatment in patients receiving androgen deprivation therapy for prostate cancer. BJU Int. 2008;102:39–43.

    Article  PubMed  Google Scholar 

  37. Higano CS. Side effects of androgen deprivation therapy: monitoring and minimizing toxicity. Urology. 2003;61(2 Suppl 1):32–8.

    Article  PubMed  Google Scholar 

  38. Nieschlag E, Swerdloff R, Behre HM, et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, and EAU recommendations. J Androl. 2006;27(2):135–7.

    Article  PubMed  CAS  Google Scholar 

  39. Morley JE, Charlton E, Patrick P, et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism. 2000;49:1239–42.

    Article  PubMed  CAS  Google Scholar 

  40. Tancredi A, Reginster JY, Schleich F, et al. Interest of the androgen deficiency in aging males (ADAM) questionnaire for the identification of hypogonadism in elderly community-dwelling male volunteers. Eur J Endocrinol. 2004;151:355–60.

    Article  PubMed  CAS  Google Scholar 

  41. Sharifi N, Gulley JL, Dahut WL. Androgen ­deprivation therapy for prostate cancer. JAMA. 2005;294(2):238–44.

    Article  PubMed  CAS  Google Scholar 

  42. Late onset hypogonadism. http://www.issam.ch/loh.asp. Accessed August 23, 2009.

  43. Tammela T. Endocrine treatment of prostate cancer. J Steroid Biochem Mol Biol. 2004;92:287–95.

    Article  PubMed  CAS  Google Scholar 

  44. Wright JL, Higano CS, Lin DW. Intermittent androgen deprivation: clinical experience and practical applications. Urol Clin N Am. 2006;33:167–79.

    Article  Google Scholar 

  45. Bhandari SM, Crook J, Hussain M. Should intermittent androgen deprivation be used in routine clinical practice? J Clin Onc. 2005;23:8212–8.

    Article  Google Scholar 

  46. Pether M, Goldenberg SL, Bhagirath K, et al. Intermittent androgen suppression in prostate cancer: and update of the Vancouver experience. Can J Urol. 2003;10:1809–14.

    PubMed  Google Scholar 

  47. Hurtado-Coll A, Goldenberg SL, Gleave ME, et al. Intermittent androgen suppression in prostate cancer: the Canadian experience. Urology. 2002;60 suppl 3:52–6.

    Article  PubMed  Google Scholar 

  48. Kurek R, Renneberg H, Lubben O, et al. Intermittent complete androgen blockade in PSA relapse after radical prostatectomy and incidental prostate cancer. Eur Urol. 1999;35 suppl 1:27–31.

    Article  PubMed  CAS  Google Scholar 

  49. Malone S, Perry G, Segal R, et al. Long-term side effects of intermittent androgen suppression therapy in prostate cancer: results of a phase II study. BJU Int. 2005;96:514–20.

    Article  PubMed  CAS  Google Scholar 

  50. Higano CS, Ellis W, Russell K, et al. Intermittent androgen suppression with leuprolide and flutamide for prostate cancer: a pilot study. Urology. 1996;48:800–4.

    Article  PubMed  CAS  Google Scholar 

  51. Crook JM, Szumacher E, Malone S, et al. Intermittent androgen suppression in the management of prostate cancer. Urology. 1999;53:530–4.

    Article  PubMed  CAS  Google Scholar 

  52. Grossfeld GD, Chaudhary UB, Reese DM, et al. Intermittent androgen deprivation: update of cycling characteristics in patients without clinically apparent metastatic prostate cancer. Urology. 2001;58:240–5.

    Article  PubMed  CAS  Google Scholar 

  53. Prapotnich D, Fizazi K, Escudier B, et al. A 10-year clinical experience with intermittent hormonal therapy for prostate cancer. Eur Urol. 2003;43:233–40.

    Article  PubMed  Google Scholar 

  54. Peyromaure M, Delongchamps NB, Debre B, et al. Intermittent androgen deprivation for biologic recurrence after radical prostatectomy: long-term experience. Urology. 2005;65:724–9.

    Article  PubMed  Google Scholar 

  55. McLeod DG. Hormonal therapy: historical perspective to future directions. Urology. 2003;61:3–7.

    Article  PubMed  Google Scholar 

  56. Calais da Silva FEC, Bono AV, Whelan P, et al. Intermittent androgen deprivation for locally advanced and metastatic prostate cancer: results from a randomized phase 3 study of the South European Uroncological Group. Eur Urol. 2009;55:1269–77.

    Article  PubMed  CAS  Google Scholar 

  57. De la Taille A, Zerbib M, Conquy S, et al. Intermittent androgen suppression patients prostate cancer. BJU Int. 2003;91:18–22.

    Article  Google Scholar 

  58. Youssef E, Tekyi-Mensah S, Hart K, et al. Intermittent androgen deprivation for patients with recurrent/metastatic prostate cancer. Am J Clin Oncol. 2003;26:e119–23.

    Article  PubMed  Google Scholar 

  59. De Leval J, Boca P, Yousef E, et al. Intermittent ­versus continuous total androgen blockade in the treatment of patients with advanced hormone-naïve prostate cancer: results of a prospective randomized multicenter trial. Clin Prostate Cancer. 2002;1:163–71.

    PubMed  Google Scholar 

  60. Oefelein MG, Resnick MI. Effective testosterone suppression for patients with prostate cancer: is there a best castration? Urology. 2003;62:207–13.

    Article  PubMed  Google Scholar 

  61. Nelson JB. 04: Hormone therapy for prostate cancer. In: Wein AJ, Kavoussi LR, Novick AC, et al., editors. Campbell-Walsh urology. 9th ed. Philadelphia, PA: Saunders Elsevier; 2007. p. 3082–100.

    Google Scholar 

  62. Mulhall JP, Morgentaler A. Penile rehabilitation should become the norm for radical prostatectomy patients. J Sex Med. 2007;4:538–43.

    Article  PubMed  Google Scholar 

  63. Wang R. Penile rehabilitation after radical prostatectomy: where do we stand and where are we going? J Sex Med. 2007;4:1085–97.

    Article  PubMed  Google Scholar 

  64. Kohler TS, Pedro R, Hendlin K, et al. A pilot study on the early use of the vacuum erectile device after radical retropubic prostatectomy. BJU Int. 2007;100:858–62.

    Article  PubMed  Google Scholar 

  65. Raina R, Pahlajani G, Agarwal A, Zippe CD. Early penile rehabilitation following prostatectomy: Cleveland clinic experience. Int J Impot Res. 2008;20:121–6.

    Article  PubMed  CAS  Google Scholar 

  66. Goldenberg SL, Bruchovsky N, Gleave ME, et al. Intermittent androgen suppression in the treatment of prostate cancer: a preliminary report. Urology. 1995;45:839–44.

    Article  PubMed  CAS  Google Scholar 

  67. Rodriguez-Rubio Cortadellas FI, Jimenez Romero ME, Gonzalez Moreno D, et al. Prolonged hypogonadism after cessation of androgen deprivation therapy for prostate cancer. Actas Urol Esp. 2009;33:747–54.

    Article  PubMed  Google Scholar 

  68. Gulley JL, Aragon-Ching JB, Steinberg SM, et al. Kinetics of serum androgen normalization and factors associated with testosterone reserve after limited androgen deprivation therapy for nonmetastatic prostate cancer. J Urol. 2008;180:1432–7.

    Article  PubMed  CAS  Google Scholar 

  69. Pickles T, Agranovich A, Berthelet E, Duncan GG, et al. Testosterone recovery following prolonged adjuvant androgen ablation for prostate carcinoma. Cancer. 2002;94:362–7.

    Article  PubMed  CAS  Google Scholar 

  70. Bong GW, Clarke HS, Hancock WC, et al. Serum testosterone recovery after cessation of long-term luteinizing hormone-releasing hormone agonist in patients with prostate cancer. Urology. 2008;71:1177–80.

    Article  PubMed  Google Scholar 

  71. Kaku H, Saika T, Tsushima T, et al. Time course of serum testosterone and luteinizing hormone levels after cessation of long-term lutinizing hormone-releasing hormone agonist treatment in patients with prostate cancer. Prostate. 2006;66:439–44.

    Article  PubMed  CAS  Google Scholar 

  72. Kureka R, Rennebergb H, Lubbenc G, et al. Intermittent complete androgen blockade in PSA relapse after radical prostatectomy and incidental prostate cancer. Eur Urol. 1999;35 suppl 1:27–31.

    Article  Google Scholar 

  73. Murthy V, Norman AR, Shahidi M, et al. Recovery of serum testosterone after neoadjuvant androgen deprivation therapy and radical radiotherapy in localized prostate cancer. BJU Int. 2006;97:476–9.

    Article  PubMed  CAS  Google Scholar 

  74. Fridmans A, Chertin B, Koulikov D, et al. Reversibility of androgen deprivation therapy in patients with prostate cancer. J Urol. 2005;173:784–9.

    Article  PubMed  CAS  Google Scholar 

  75. Hadziselimovic F, Senn E, Bandhauer K. Effect of treatment with chronic gonadotropin releasing ­hormone agonist on human testis. J Urol. 1987;138:1048.

    PubMed  CAS  Google Scholar 

  76. Huhtaniemi I, Nikula H, Parvinen M, et al. Histological and functional changes of the testis tissue during GnRH agonist treatment of prostatic cancer. Am J Clin Oncol. 1988;11(suppl):S11.

    Article  PubMed  Google Scholar 

  77. Muller A, Deveci S, Tal R, et al. Assessment of the use of sildenafil citrate for the protection of erectile tissue and function following castration in the rat model. Abstract at the AUA meeting 2008.

    Google Scholar 

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Authors and Affiliations

  1. Division of Urology, University of Texas Medical School at Houston, 6431 Fannin Street, MSB 6.018, Houston, TX, 77030, USA

    Run Wang

  2. Department of Urology, The University of Texas MD Anderson Cancer Center at Houston, Houston, TX, 77030, USA

    Run Wang

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  1. Claudio A. Romero
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  2. Anthony N. Hoang
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  3. Run Wang
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Correspondence to Run Wang .

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Editors and Affiliations

  1. Sexual Medicine Program, Memorial Sloan-Kettering Cancer Center, East 68th Street 353, New York, 10021, New York, USA

    John P. Mulhall

  2. Daniel den Hoed Cancer Center, Dept. Radiation Oncology, Erasmus Medical Center, Groene Hilledijk 301, Rotterdam, 3075 EA, Netherlands

    Luca Incrocci

  3. Alvarado Hospital, Alvarado Road 6719, San Diego, 92120, California, USA

    Irwin Goldstein

  4. New England Research Institutes, Galen Street 9, Watertown, 02472, Massachusetts, USA

    Ray Rosen

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Romero, C.A., Hoang, A.N., Wang, R. (2011). Impact of Androgen Deprivation Therapy on Men’s Sexual Health. In: Mulhall, J., Incrocci, L., Goldstein, I., Rosen, R. (eds) Cancer and Sexual Health. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-60761-916-1_34

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