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The impact of androgen deprivation therapy on compliance with intracavernous injections

Torremade, J1; Kagacan, C1; Narus, J1; Mulhall, JP1

1: Memorial Sloan Kettering Cancer Center, USA

Objectives: Androgen deprivation therapy (ADT) for prostate cancer lowers testosterone to castrate levels resulting in loss of sex drive, difficulty achieving orgasm and erectile tissue structural changes. Intracavernous injections (IC) are well recognized as a strategy for treating ED and are used regularly in erectile rehabilitation programs for men after radical prostatectomy and prostate radiation. There is no available literature on the compliance of men on IC who are concomitantly on ADT.

Material and Methods: Men with ED who had failed maximum dose PDE5 inhibitor agents; were enrolled in our IC program for ≥12 months (m); men treated with radiation therapy (RT) alone were compared to men who had had RT combined with ADT (and were still using ADT). 12 month follow-up or longer was required to be included in the analysis. Demographic, comorbidity, sexual function and sexual activity data were recorded. IC compliance was defined as use of IC ≥1/month and patients were followed at 3 months (m), 6m and 12 months after initial in-office IC training. Multivariable analysis was performed to define predictors of continued use of IC at 12 m after training completion.

Results: 410 men were included: 216 RT alone, 194 RT+ADT. Mean age 67±14 years; RT type was IMRT 226, brachytherapy 184; 82% of men were partnered (no difference between groups in any of these 3 factors). IC compliance for RT alone and RT+ADT groups was: @3m 84% vs 41%; @6m 76% vs 22%; @12m 81% vs 10% (all p<0.01). Predictors of IC compliance at 12 m after training are listed in Table.

Conclusion: RT patients exposed to ADT struggle to comply with IC therapy despite understanding the role it might play in erectile rehabilitation of such patients. Younger, partnered and historically sexually active men were more likely to continue injection therapy long-term.


95% CI

P value

Patient age ≤50y








Pre-ADT sexual activity ≥4/m









Work supported by industry: no.

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