Prostate cancer: could physical exercise be the key to regaining an active sexual life?

Sexual dysfunction is a common side effect of prostate cancer treatments, impacting patients’ quality of life well beyond the acute phase of disease. Despite pharmacological progress, current therapeutic approaches often fail to sufficiently address the physical, psychological, and relational components involved. This highlights the need for more holistic strategies, particularly through structured physical activity and psycho-sexual education.   The randomized trial presented here evaluates the impact of a supervised exercise program, with or without a psycho-sexual and self-management intervention (PESM), on sexual function in men undergoing or having completed prostate cancer treatment. The primary objective was to assess effects on erectile function using the IIEF score, with secondary analysis of changes in body composition, muscle strength, and functional performance.   What clinical benefits can exercise realistically provide for sexual function after prostate cancer?   A total of 112 men (mean age: 66.3 years) were randomly assigned to three groups: exercise alone (n=39), exercise + PESM (n=36), and usual care (n=37). The exercise program consisted of three supervised weekly sessions for six months, combining resistance training and moderate-to-high intensity cardiovascular exercise under the supervision of an exercise physiologist. The PESM group also received cognitive-behavioral support, educational audio/written material, and individualized management plans.   Erectile function, measured via the IIEF score, increased by 3.5 points in the exercise group compared with usual care (p = 0.04), exceeding the minimal clinically significant improvement threshold of 4 points. The effect was particularly pronounced in patients treated with radiotherapy or androgen deprivation therapy (ADT), compared with those who had undergone prostatectomy.   Other domains of sexual function (libido, satisfaction, sexual activity) also showed positive trends, although not statistically significant. Notably, patients with the lowest baseline scores experienced the greatest improvements, suggesting increased benefit among those with severe dysfunction.   Physically, exercise led to: • A reduction in fat mass (−0.9 kg; p = 0.02),  • Improved upper-body (+9.4 kg) and lower-body muscle strength (+17.9 kg) (p < 0.001),  • Improved functional capacity, including chair rise performance (−1.8 s; p = 0.002).    The addition of the psycho-sexual component (PESM) did not produce significant improvement compared with exercise alone. This suggests that the intensity or structure of the intervention may have been insufficient to yield measurable short-term effects.   Integrating exercise into supportive care  This study demonstrates that structured physical exercise is an effective and clinically relevant intervention to improve erectile function and sexual satisfaction in men treated for prostate cancer. While theoretically valuable, PESM did not enhance the effects of exercise in the specific format tested.   Limitations include a modest sample size (the study ended before reaching the initially planned 240 participants), single geographical location (Western Australia), and possible selection bias due to a motivated and functionally capable study population.   Looking ahead, it seems essential to: • Include exercise in standard post-treatment care recommendations for prostate cancer,  • Tailor programs to baseline severity of sexual dysfunction,  • Explore more intensive or personalized psycho-sexual education formats,  • Raise clinician awareness of sexual recovery as an integral part of cancer survivorship.    Integrating physical activity into care pathways represents an accessible, non-pharmacological, and effective approach to supporting sexual quality of life in prostate cancer patients.