Defining sexual outcomes after treatment for localized prostate carcinoma

Abstract

BACKGROUNDThe objective of this survey was to identify factors associated with good sexual outcomes in a large group of survivors of localized prostate carcinoma.METHODSA postal survey was sent to 2636 men in the Cleveland Clinic Foundation's Prostate Cancer Registry who either were treated with definitive radiotherapy or underwent prostatectomy for localized prostate carcinoma. The survey asked about demographic items, past and current sexual functioning, partner's sexual function and health, and a number of factors hypothesized to affect sexual satisfaction. Standardized questionnaires included the Sexual Self‐Schema Scale‐Male Version, the International Index of Erectile Function (IIEF), urinary and bowel symptom scales from the Los Angeles Prostate Cancer Index, and the Short Form Health Survey (SF‐36).RESULTSThe return rate was 49%, yielding a sample of 1236 men at an average of 4.3 years post‐treatment. Comparing responders with nonresponders suggested that the sample may have been somewhat biased toward men who were more interested in maintaining sexual function. At the time they were diagnosed with prostate carcinoma, 36% of men had erectile dysfunction (ED). Within the past 6 months, however, 85% of men reported having ED. Only 13% of men were having reliable, firm erections spontaneously, and another 8% of men were having erections with the aid of a medical treatment. Men were as distressed about loss of desire and trouble having satisfying orgasms as they were about ED. Of the 84% of men who reported having a current sexual partner, 66% indicated that she had a sexual problem. Younger age was associated strongly with better sexual outcome (global IIEF score). With demographic factors taken into account, better sexual outcome was related significantly to medical factors, including not having neoadjuvant or current antiandrogen therapy, undergoing bilateral nerve‐sparing prostatectomy or brachytherapy, and having better mental and physical health composite scores on the SF‐36. Sexual factors that were associated with a better outcome included having normal erections before treatment for prostate carcinoma, choosing a treatment based on the hope that it would preserve sexual function, having more sexual partners in the past year, and having a sexually functional partner.CONCLUSIONSThe great majority of men who survive prostate carcinoma do not achieve a return to functional sexual activity in the years after treatment. The priorities a man places on sexuality and on having a sexually functional partner are important factors in sexual satisfaction at follow‐up, over and above the influence of age and medical factors. Cancer 2002;95:1773–85. © 2002 American Cancer Society.DOI 10.1002/cncr.10848

“I wish I’d told them”: A qualitative study examining the unmet psychosexual needs of prostate cancer patients during follow-up after treatment

“…Their accounts offer some explanations as to why psychosexual needs were not currently being met by existing follow-up arrangements. Most prostate cancer patients seek support for sexual dysfunction at an early stage following treatment [52]. However, the data presented here show that the psychological consequences of the loss of sexual function may only manifest years after treatment when the imminent threat to survival passes [6,53].…”

The psychosocial aspects of sexual recovery after prostate cancer treatment

“…32 Factors that characterize men seeking help are younger age, available sexual partners, better physical and psychological health, more education, greater financial well being and nerve-sparing surgical treatment. 3,4,33 Schover et al 26 found that men with sexual self-confidence and positive attitudes toward obtaining help were more likely to seek help than others, and that help seeking may be associated with the earliest stage of illness, before biochemical failure. 33 Matthew et al 3 hypothesize that psychological barriers may affect men's help seeking for erectile dysfunction.…”

“…1 Erectile dysfunction is defined as the incapacity to achieve and maintain a penile erection sufficient to attain satisfactory sexual relations. 2 Erectile dysfunction occurs in 25-85% of patients after surgical treatments (that is, prostatectomy), 3,4 in 32-67% after radiation treatment, 5 and in approximately 71% following short-term neoadjuvant hormonal therapy. 6 Erectile dysfunction occurs immediately after a prostatectomy with recovery of erection, often partial, taking up to, approximately, 2 years.…”

Promoting recovery of sexual functioning after radical prostatectomy with group-based stress management: The role of interpersonal sensitivity

“…34 Although surgical removal of the prostate gland is associated with a high 10 year survival rate in localized cases (93%), 34 sexual dysfunction is a common and often enduring side effect of this treatment. [35][36][37] In one major survey, 85% of patients reported experiencing some erectile dysfunction within the last 6 months even 4.3 years after treatment, and 61% reported moderate or extreme distress relating to this dysfunction. 35 Prior work has indicated that psychological interventions directed at psychoeducation or teaching stress management skills can improve aspects of quality of life in men recovering from PCa treatment.…”

“…[35][36][37] In one major survey, 85% of patients reported experiencing some erectile dysfunction within the last 6 months even 4.3 years after treatment, and 61% reported moderate or extreme distress relating to this dysfunction. 35 Prior work has indicated that psychological interventions directed at psychoeducation or teaching stress management skills can improve aspects of quality of life in men recovering from PCa treatment. [38][39] Less is known about how these interventions affect physical recovery-including recovery of sexual functioning-after medical treatments are completed.…”