Changes in specific domains of sexual function and sexual bother after radical prostatectomy

Abstract

Study Type – Therapy (outcomes research) Level of Evidence 2c OBJECTIVE To quantitatively assess the effect of radical prostatectomy (RP) on the specific domains that comprise overall sexual function (SF), focusing on the relationships among these domains and overall SF, and to identify predictors for recovery of SF over time, as a decline in SF and sexual bother (SB) are known potential complications of treatment for prostate cancer. PATIENTS AND METHODS Within the Cancer of the Prostate Strategic Urologic Research Endeavor database, we identified men diagnosed between 1995 and 2001 with localized prostate cancer treated with RP. SF and SB outcomes, measured using the University of California Los Angeles Prostate Cancer Index, were assessed at 6‐month intervals for 4 years after RP. RESULTS In all, 620 men met the study criteria; at 6 months after RP, overall and all the specific domains of SF declined, with improvement in most specific domains by 2 years after RP. The greatest declines were in the ability to achieve erections, high‐quality erections, and frequent erections; these domains were also most strongly correlated with overall SF. Sexual desire was relatively preserved, and there was a weak correlation between overall SF and sexual desire after RP, when there was the greatest discrepancy between sexual desire and other domains of function. SB showed continued improvement over time to 4 years but was not well correlated with any measurements of SF assessed. Younger age, college education, sexual aid and medication use, the absence of comorbid conditions, and nerve‐sparing surgery were predictive of significant recovery of function in several specific domains of SF. CONCLUSIONS RP affects specific domains of SF to differing degrees. Compromised erectile function is most commonly reported among these specific domains and seems to play a more dominant role in determining overall SF, but notably none of the domains of function were closely linked to SB. Because education is protective in the perception of bother, appropriate counselling and the setting of expectations for outcomes in overall and specific domains of SF might lead to improved quality of life after treatment for prostate cancer.

Prevalence and Predicting Factors for Commonly Neglected Sexual Side Effects to Radical Prostatectomies: Results from a Cross-Sectional Questionnaire-Based Study

“…This is in line with a study performed by Salonia et al., who found that UI and ED were correlated with orgasmic dysfunction [19]. In addition, previous studies have found nerve sparing, a prostate weight <59 g, lower age, good erectile function, no comorbidities, ED treatment, and higher levels of education to be protective of orgasmic function [15,17,19–21]. These results were not replicated in this dataset.…”

A randomized trial of internet‐based versus traditional sexual counseling for couples after localized prostate cancer treatment

“…Men experience a range of sexual problems after prostate cancer treatment, including low desire, difficulties reaching orgasm, and problems with painful sex 7, 40, 41. The IIEF total score assesses the full range of sexual function and satisfaction, suggesting that the intervention is broadly effective 30, 38…”

Sexual Dysfunction Following Radical Prostatectomy

“…The importance of counseling patients, both before and after surgery, has been established regarding sexual dysfunction and the use of PDE5 inhibitors postoperatively (Bronner et al, 2010). In a subset of 620 men from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database, sexual function and sexual bother were evaluated after administration of the Prostate Cancer Index survey, both at baseline and up to 4 years postoperatively (Le et al, 2010). Sexual desire was shown to have the smallest decrease from baseline following surgery, and it did not improve with time (Le et al, 2010).…”

“…In a subset of 620 men from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database, sexual function and sexual bother were evaluated after administration of the Prostate Cancer Index survey, both at baseline and up to 4 years postoperatively (Le et al, 2010). Sexual desire was shown to have the smallest decrease from baseline following surgery, and it did not improve with time (Le et al, 2010). The other domains of sexual function such as erection and orgasm were more likely to recover over time (Le et al, 2010).…”

“…Sexual desire was shown to have the smallest decrease from baseline following surgery, and it did not improve with time (Le et al, 2010). The other domains of sexual function such as erection and orgasm were more likely to recover over time (Le et al, 2010). Researchers have highlighted the interaction between sexual desire and sexual function, indicating that sexual desire associated with inadequate function resulted in poorer QoL measures (Dahn et al, 2004).…”