Pursuit of sexual function post-radical prostatectomy

Abstract

Introduction: In the event of the implementation of prostate cancer screening, younger men will be diagnosed more frequently. Erectile dysfunction (ED) is a frequent long-term complication in men post-radical prostatectomy (RP). Since the introduction of RP, urologists have strived to improve postoperative sexual function. There is little literature, however, in the area of ED prescribing and sexual pursuit in men post-RP. We assessed the pursuit of sexual function in this group of patients. Methods: The study involved a detailed questionnaire sent to patients who have undergone radical retropublic prostatectomy (RRP) by one surgeon in one institution to ascertain the impact of ED on lifestyle and ED therapy prescription use. Results: There was a response rate of 59%; most patients who responded were in the 61 to 70 year age group at the time of the survey. About 25% of patients had intercourse more than once in the 4 weeks prior to the survey. A total 50% of patients had no problem or a very small problem with their sexual function. Overall 80% of patients were prescribed ED therapy, but less than 35% of them used it. Conclusion: Sexual frequency peaked in younger patients who were 3 years or more from surgery. Of note, 46% of men either declined the offer of ED therapy or got the prescription and never used it. Only 34% of men had used their ED prescription in the last 4 weeks. Urologists frequently find that patients behave differently postoperatively, with less interest in sexual activity. Interestingly, we found that 50% of our patients classified their sexual function, as at most a small problem. IntroductionProstate cancer is the most common non-cutaneous malignancy affecting men. Its incidence is set to increase by 275% in Ireland over the next 10 years.1 There has been an increase in the number of young men diagnosed with clinically localized disease. As quality of life is more important and rates of distress from erectile dysfunction (ED) are higher in this age group, there is much controversy about ED postradical prostatectomy (RP). RP is the gold standard for organ-confined disease. Unfortunately, there are significant long-term complications as a result of RP, such as urinary incontinence and ED. Landmark work by Walsh and colleagues in the 1980s led to the development of the nerve-sparing RRP.2 These authors reported potency rates of 86% after bilateral nervesparing prostatectomy. 3 The rates of ED post-RP vary greatly in the literature, from 40% to 75%. 4 The introduction of new technologies (laparoscopic and robotic) has led to improved incontinence rates, however ED remains a significant longterm side effect of treatment. Potency rates at 12 months vary for laparoscopic RP from 48% to 72%, 5,6 and from 58% to 80% for robotic. 7,8 We reviewed men who have undergone RRP in our department to assess their level of erectile function and pursuit of sexual function. Although there is plenty of literature on ED post-RRP, there is little investigation into the pursuit of improved sexual function,...

Importance of considering interest in sex when evaluating satisfaction after robot‐assisted radical prostatectomy

“…This hypothesis is supported by previous studies, wherein patients with high‐risk prostate cancer tended to experience psychological stress about their cancer outcome rather than their sexual activity soon after RARP 17 . Another study on sexual activity after RARP reported that patients take a long time to recover their interest in sex 18 . Another possible reason is that high expectations for SF recovery eventually caused dissatisfaction due to the naturally slow recovery of SF after RARP.…”

“…17 Another study on sexual activity after RARP reported that patients take a long time to recover their interest in sex. 18 Another possible reason is that high expectations for SF recovery eventually caused dissatisfaction due to the naturally slow recovery of SF after RARP. In fact, patients with higher expectations for postoperative status tend to experience regret after RARP.…”

Validity of the Patient-Reported Outcome Measurement Information System (PROMIS) Sexual Interest and Satisfaction Measures in Men Following Radical Prostatectomy

“…Visit (mo) It has been demonstrated that, in discussing treatment options for men with localized prostate cancer, urologists rarely discuss patients' interest in sex. 29 We demonstrate the importance of the evaluation of interest and satisfaction measures over time and show that, despite preconceived notions from prior studies indicating low interest in sex after radical prostatectomy, 30 this cohort of patients had high interest in sex after radical prostatectomy with a significant increase in interest from 3 to 24 months after prostatectomy. This may indicate that as men are cured of prostate cancer, they shift their focus from survival to quality of life.…”

“…However, studies show that 24 months is the time point of optimal recovery of sexual function, 35 with rates of sexual activity in some cases peaking at 3 to 6 years after surgery. 30 It is possible that beyond 24 months, we might see changes in interest and satisfaction because there may be continued improvement in erectile function and adaptation of patients and their partners. In addition, we only evaluated these measures in patients after radical prostatectomy; they could potentially be useful in patients after other treatments for prostate cancer, including radiotherapy.…”

Development and Validation of Dynamic Multivariate Prediction Models of Sexual Function Recovery in Patients with Prostate Cancer Undergoing Radical Prostatectomy: Results from the MUSIC Statewide Collaborative

“…We did not include outcomes beyond 24 months. Although recovery of sexual function is uncommon beyond 24 months, there is some evidence that sexual activity recovery after surgery in some cases peaks at 3–6 yr after surgery [30] , [31] . In addition, this model is only applicable to patients considering RP and does not predict sexual function following other prostate cancer treatments such as radiation therapy.…”