Impact of neoadjuvant relugolix on patient-reported sexual function and bother

Jessica Y Hsueh; Lindsey Gallagher; Min Ji Koh; Shaine Eden; Sarthak Shah; Markus Wells; Malika Danner; Alan Zwart; Marilyn Ayoob; Deepak Kumar; Paul Leger; Nancy A Dawson; Simeng Suy; Rachel Rubin; Sean P Collins

doi:10.3389/fonc.2024.1377103

Impact of neoadjuvant relugolix on patient-reported sexual function and bother

Front Oncol. 2024 Apr 11:14:1377103. doi: 10.3389/fonc.2024.1377103. eCollection 2024.

Authors

Affiliations

¹ Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States.
² Systems Medicine Program, Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC, United States.
³ Biotechnology Research Institute, North Carolina Central University, Durham, NC, United States.
⁴ Department of Oncology, Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC, United States.
⁵ Department of Urology, MedStar Georgetown University Hospital, Washington, DC, United States.

Abstract

Introduction: Sexual function following local treatment for prostate cancer is an important quality of life concern. Relugolix is a novel oral GnRH receptor antagonist used in combination with radiation therapy in the treatment of unfavorable prostate cancer. It has been shown to achieve rapid and profound testosterone suppression. As a result, these very low testosterone levels may impact both sexual functioning and perceptions. This prospective study sought to assess neoadjuvant relugolix-induced sexual dysfunction prior to stereotactic body radiation therapy (SBRT).

Methods: Between March 2021 and September 2023, 87 patients with localized prostate cancer were treated with neoadjuvant relugolix followed by SBRT per an institutional protocol. Sexual function and bother were assessed via the sexual domain of the validated Expanded Prostate Index Composite (EPIC-26) survey. Responses were collected for each patient at pre-treatment baseline and after several months of relugolix. A Utilization of Sexual Medications/Devices questionnaire was administered at the same time points to assess erectile aid usage.

Results: The median age was 72 years and 43% of patients were non-white. The median baseline Sexual Health Inventory for Men (SHIM) score was 13 and 41.7% of patients utilized sexual aids prior to relugolix. Patients initiated relugolix at a median of 4.5 months (2-14 months) prior to SBRT. 95% and 87% of patients achieved effective castration (≤ 50 ng/dL) and profound castration (< 20 ng/dl) at SBRT initiation, respectively. Ability to have an erection, ability to reach orgasm, quality of erections, frequency of erections, and overall sexual function significantly declined following relugolix. There was a non- significant increase in sexual bother.

Discussion: In concordance with known side effects of androgen deprivation therapy (ADT), neoadjuvant relugolix was associated with a significant decline in self-reported sexual function. However, patients indicated only a minimal and non-significant increase in bother. Future investigations should compare outcomes while on relugolix directly to GnRH agonist-induced sexual dysfunction.

Keywords: androgen deprivation therapy (ADT); bother; prostate cancer; relugolix; sexual function; stereotactic body radiation therapy (SBRT).

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The Department of Radiation Medicine at Georgetown University Hospital receives a grant from Accuray to support a research coordinator. This work was supported by The James and Theodore Pedas Family Foundation. SC and DK acknowledge the grant R01MD012767 from the National Institute on Minority Health and Health Disparities.