Abstract Introduction Prostate cancer (PC) remains the second most commonly diagnosed malignancy among men worldwide. Curative-intended treatments such as radical prostatectomy (RP) and radiotherapy (RT) achieve excellent oncological control but are frequently associated with substantial declines in sexual function, which can profoundly affect long-term quality of life. Real-world data on these functional outcomes remain limited across treatment modalities and global healthcare settings. Objective To assess changes in sexual function and sexual aid use 12 months after curative treatment for localized or locally advanced PC using data from the international TrueNTH Global Registry (TNGR). Methods The TNGR is a prospective, multicenter registry that collects standardized clinical and patient-reported outcomes from more than 200 institutions in 17 countries. Men diagnosed with localized or locally advanced PC between 2016 and 2022 and with valid Expanded Prostate Cancer Index Composite (EPIC-26) data at baseline and 12 months post-treatment were included. In total, 13,413 patients were analyzed: RP (85%), external beam radiation therapy (EBRT) only (9%) or with additional androgen deprivation therapy (EBRT + ADT, 4%), and brachytherapy (BRT, 1%). Descriptive and comparative analyses were conducted (p 0.05). Results Baseline sexual function domain scores (SFDS) differed significantly across modalities, highest after BRT (median 44.0, IQR 22.2–58.3) and lowest after EBRT only (30.5, IQR 16.7–52.8; p0.0001). After 12 months, SFDS declined markedly in all groups, most pronounced after RP (–60%) and least after BRT (–40%). Erectile function deterioration was reported by up to 90% of RP patients, with similar though slightly lesser declines after EBRT ± ADT. Sexual bother increased in all groups over time. Sexual aid use increased modestly post-treatment - most notably in RP (+64.5%) and BRT (+51%) - but remained low overall (7%). In RP patients, multivariate analysis confirmed baseline sexual function, age, NCCN risk, and nerve-sparing intent as key determinants of 12-month outcomes. Conclusions All treatment modalities led to significant declines in sexual function and significant increase in sexual bother within the first year, most severe after RP and EBRT only. Despite marginal increases in aid use, overall utilization remained low, suggesting underuse of available rehabilitation options. These findings emphasize the importance of comprehensive pre-treatment counseling addressing expected and structured support programs to optimize long-term sexual health and improve quality of life as integral components of prostate cancer survivorship care. Disclosure No
Hess et al. (Mon,) studied this question.