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da Fonseca Pedroso IM, Siqueira MLS, de Sousa Santos TABP, de Paula Barbosa K, de Lima EAN, Sampaio ACRI, da Costa Cunha K, da Silva ML, Alves AT. Conservative treatment of sexual dysfunction among men undergoing prostate cancer treatment: a systematic review. Sex Med Rev 2024; 12:710-719. [PMID: 38936816 DOI: 10.1093/sxmrev/qeae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION One of the changes caused by pelvic cancers is the decrease in patients' sexual function, which influences their quality of life (QoL) during and after treatment. Sexual dysfunction (SD) is associated with severe ejaculatory dysfunction, sexual dissatisfaction, reduced libido and sexual desire, decreased intensity of orgasm, difficulty in erection, and lower sexual frequency. OBJECTIVES This systematic review investigated the effectiveness of conservative treatments (nonsurgical and nonpharmacologic) for SD in males with pelvic cancer. METHODS Systematic searches were performed in the Cochrane Library, PubMed, CINAHL, PEDro, Embase, and VHL databases in September 2023 by using MeSH terms related to population, study design, intervention, and outcome. RESULTS Only prostate cancer studies were included due to a lack of studies in other treatments. Studies used pelvic floor muscle training (8 studies); biofeedback (1 study); a penile vibrator (1 study); electrostimulation (2 studies); shock wave therapy (2 studies); aerobic, resistance, and flexibility exercises (2 studies); and a vacuum erection device (1 study). All articles assessed sexual function and reported improvements in the intervention group, including 5 with no differences between the groups. Articles involving shock wave therapy described improvements in SD but were not clinically relevant. Studies evaluating QoL reported benefits in the experimental groups. Adverse effects of a vacuum erection device and penile vibrator were reported. CONCLUSION Conservative treatments are more effective than others in treating SD in men with prostate cancer. Further studies are needed to assess the unwanted effects of these treatments. In this study, we found evidence that this type of therapy improves sexual function and QoL in this population.
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Affiliation(s)
| | | | | | - Keyla de Paula Barbosa
- Rehabilitation Sciences Program, Department of Physiotherapy, Faculty of Ceilândia, University of Brasília, Brasília, 72225290, Brazil
| | - Elio Armando Nunes de Lima
- Rehabilitation Sciences Program, Department of Physiotherapy, Faculty of Ceilândia, University of Brasília, Brasília, 72225290, Brazil
| | | | - Katiane da Costa Cunha
- Center for Biological and Health Sciences, State University of Pará, Belém, 68502-100, Brazil
| | | | - Aline Teixeira Alves
- Rehabilitation Sciences Program, Department of Physiotherapy, Faculty of Ceilândia, University of Brasília, Brasília, 72225290, Brazil
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Shah FI, MacLeod F, Walker LM. Patient Reported Sexual Adaptation Following Prostate Cancer Treatment: An Analysis of Related Variables and Sexual Outcomes Associated with Sexual Adaptation Styles. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2377-2395. [PMID: 38609584 DOI: 10.1007/s10508-024-02855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 04/14/2024]
Abstract
Sexual concerns after prostate cancer (PCa) treatment are high. Flexible coping is a crucial element to maintaining sexual activity after PCa and improves adaptation outcomes. We aimed to identify potential sexual adaptation styles reported by men following PCa treatment, and to assess relationships among associated variables and outcomes. Individuals (n = 223) with PCa treatment history (e.g., radical prostatectomy [n = 165, 74.0%], external beam radiation [n = 83, 37.2%], hormone/androgen deprivation therapy [n = 83, 37.2%]), completed an online survey assessing sexual variables and processes of sexual adaptation. Using a combination of inductive and deductive coding, open-ended responses were thematically analyzed and grouped into sexual adaptation styles. Factors potentially associated with sexual adaptation styles (e.g., age, perceived partner involvement, co-morbidities, relationship duration, time since PCa treatment, desire for physical affection, depression, relationship adjustment) were tested using multinomial logistic regression. Outcomes of sexual well-being (sexual distress, sexual bother, sexual satisfaction) and relationship adjustment were compared against each sexual adaptation style using a multivariate analysis of variance. Sexual activity status and satisfaction with the adaptation process was assessed across the sexual adaptation styles using a chi-square analysis and post-hoc tests. Two distinct categories were identified: those who had Adapted (n = 185) and those who had Not Adapted (n = 38). Four sexual adaptation styles emerged in the adapted category: Relationship Renegotiation (n = 53) and Sexual Renegotiation (n = 47), which were couples-focused styles, and Acceptance/Resignation (n = 34) and Masturbation/Erection (n = 48), which were individual-focused styles. Participants who could not be categorized as one style, but rather met several, were identified as Mixed (n = 3). Higher rates of depression, lower relationship adjustment, lack of sexual activity, and greater dissatisfaction with the adaptation process were observed for Not Adapted participants. Participants engaged in any type of adaptation style fared better than those who had Not Adapted. Couples-focused styles tended to emphasize renegotiation, including a changed perspective on the expression of the relationship. Perceived direct engagement of the partner facilitated adaptation and emphasized engagement with flexible coping, either through redefining priorities or ways of being sexual. Individual-focused styles emphasized pre-cancer erectile function, and either aimed to return to capacity for penetrative sexual activity or accepted its inaccessibility and largely an abandonment of partnered sexual activity.
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Affiliation(s)
- Fatima I Shah
- Department of Oncology, University of Calgary, Calgary, AB, T2N 4N2, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Fiona MacLeod
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
| | - Lauren M Walker
- Department of Oncology, University of Calgary, Calgary, AB, T2N 4N2, Canada.
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada.
- Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada.
- Department of Psychology, University of Calgary, Calgary, AB, Canada.
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Xu RN, Ma JX, Zhang X, Liao ZD, Fu YJ, Lv BD. Efficacy of Chinese Herbal Medicine Formula in the Treatment of Mild to Moderate Erectile Dysfunction: Study Protocol for a Multi-Center, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. Int J Gen Med 2023; 16:5501-5513. [PMID: 38034900 PMCID: PMC10683653 DOI: 10.2147/ijgm.s436347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Erectile dysfunction (ED) is a prevalent condition in urology, primarily managed with PDE5 inhibitors (PDE5Is). However, approximately 20% of patients do not experience improvement in overall sexual satisfaction (OS) after taking PDE5Is. Among these, traditional Chinese medicine (TCM) has emerged as a complementary approach, with formulas like Hongjing I granules (HJIG) showing promise in preliminary studies. This study aims to rigorously evaluate the effectiveness and safety of HJIG in mild to moderate ED cases, assessing improvement in both sexual function and TCM pattern alignment. Methods This study is a randomized, double-blind, placebo-controlled multicentre trial. Recruitment will be conducted from patients who have a strong willingness to try using only traditional Chinese medicine treatment (This is very common in traditional Chinese medicine hospitals.). A total of 100 patients diagnosed with mild to moderate ED caused by qi deficiency and blood stasis will be recruited and randomly assigned to receive one of two treatments: HJIG (N = 50) or placebo (N = 50). Patients will receive 8 weeks of treatment and a 16-week follow-up starting from the fourth week of treatment. Outcome measures, including the International Index of Erectile Function-Erectile Function domain (IIEF-EF) score, Sexual Encounter Profile (SEP), and Traditional Chinese Medicine symptom score, will be evaluated. Discussion The expected outcome of this trial is that the use of the herbal formula HIJG alone can improve overall sexual satisfaction (OS) in patients with mild to moderate ED, while also improving their traditional Chinese medicine symptom scores. This will provide evidence-based support for the use of Chinese medicine in the treatment of ED in China. Trial Registration Chinese Clinical Trial Registry, ChiCTR2000041127, Registered on 19 December 2020, https://www.chictr.org.cn/showproj.html?proj=46469. Trial Status Recruitment began in March 2021, therefore 80 patients have been recruited. It is expected to finish recruiting in December 2023.
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Affiliation(s)
- Run-Nan Xu
- The Second Affiliated Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jian-Xiong Ma
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xin Zhang
- The Second Affiliated Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Ze-Dong Liao
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yi-Jia Fu
- The Second Affiliated Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Bo-Dong Lv
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
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Kemerer BM, Zdaniuk B, Higano CS, Bossio JA, Camara Bicalho Santos R, Flannigan R, Brotto LA. A randomized comparison of group mindfulness and group cognitive behavioral therapy vs control for couples after prostate cancer with sexual dysfunction. J Sex Med 2023; 20:346-366. [PMID: 36763954 DOI: 10.1093/jsxmed/qdac038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/17/2022] [Accepted: 11/22/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Sexual dysfunction is the most common and most distressing consequence of prostate cancer (PCa) treatment and has been shown to directly affect the sexual function and quality of life of survivors' partners. There are currently no established therapies to treat the emotional and psychological burden that sexual issues impose on the couple after PCa. AIM Our study examined the impact of 2 therapies-cognitive behavioral therapy (CBT) and mindfulness therapy-on sexual, relational, and psychological outcomes of PCa survivor and partner couples. METHODS PCa survivors (n = 68) who self-reported current sexual problems after PCa treatments and their partners were randomized to 4 consecutive weeks of couples' mindfulness therapy, couples' CBT, or no treatment (control). OUTCOMES Couples' sexual distress, survivors' sexual satisfaction, and couples' relationship satisfaction, quality of life, psychological symptoms (anxiety and depression), and trait mindfulness were measured at baseline, 6 weeks after treatment, and 6 months after treatment. RESULTS Sexual distress and sexual satisfaction were significantly improved 6 weeks after the CBT and mindfulness interventions as compared with the control group, but only sexual distress remained significantly improved at 6 months. Relationship satisfaction decreased and more so for partners than survivors. There were increases in domains of quality of life for survivors vs their partners 6 months after treatments and an overall increase in general quality of life for couples 6 weeks after mindfulness. There were no significant changes in psychological symptoms and trait mindfulness. Qualitative analysis showed that the mindfulness intervention led to greater personal impact on couple intimacy after the study had ended. CLINICAL IMPLICATIONS CBT and mindfulness can be effective treatments for helping couples adapt to and cope with changes to their sexual function after PCa treatments and could help improve the most common concern for PCa survivors-that is, couples' sexual intimacy-after cancer, if added to routine clinical care. STRENGTHS AND LIMITATIONS We used established standardized treatment manuals and highly sensitive statistical methodology and accounted for covariable factors and moderators of primary outcomes. Due to difficulty in recruitment, we had a smaller control group than treatment, reducing our power to detect between-group differences. Our sample was mostly White, heterosexual, and affluent, thereby limiting the generalizability. CONCLUSION This is the first randomized clinical trial to test and demonstrate benefits among PCa survivors and partners' sexual outcomes after CBT and mindfulness as compared with a nontreatment control group.
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Affiliation(s)
- Bibiana M Kemerer
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Celestia S Higano
- Prostate Cancer Supportive Care Program, Vancouver Coastal Health, Vancouver, BC, V5Z 1M9, Canada.,Department of Urologic Sciences, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Jennifer A Bossio
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON K7L 2V7, Canada.,Department of Urology, Queen's University, Kingston, ON K7L 2V7, Canada
| | | | - Ryan Flannigan
- Prostate Cancer Supportive Care Program, Vancouver Coastal Health, Vancouver, BC, V5Z 1M9, Canada.,Department of Urologic Sciences, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada.,Department of Urology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
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5
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Hard Times: Prostate Cancer Patients' Experiences with Erectile Aids. J Sex Med 2021; 18:1775-1787. [PMID: 37057492 DOI: 10.1016/j.jsxm.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/25/2021] [Accepted: 07/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prostate cancer (PCa) treatments commonly lead to erectile difficulties. While the mainstay treatment is erectile aids (EAs) to promote erectile recovery, some men never use these treatments and those whose do use EAs often abandon them in the long-term. AIM The goal of this study was to examine PCa patients' experiences with EAs, to elucidate relationships between experiences with EAs on psychological and sexual well-being, and to explore benefits and drawbacks to EA use. METHODS A self-report survey including validated questionnaires was administered to examine PCa patients' use and perceptions of helpfulness of EAs, and to characterize associations between use, perceived helpfulness, and psychological and sexual well-being. The survey was followed by an open-ended prompt to explore participants' experiences with EAs. OUTCOMES We surveyed 260 North American men, up to 25 years after receiving treatment for PCa. Three groups of patients were observed, including those who used EAs and perceived them to be helpful, those who used EAs and perceived them to be unhelpful, as well as a smaller group of patients who never used EAs. RESULTS Around 80% of the sample were using or had used EAs. Despite the high frequency of use, not all men found EAs helpful. Men who used EAs and found them unhelpful reported poorer psychological and sexual well-being compared to men who didn't use aids or who used EAs but found them helpful. Results indicated both benefits and drawbacks to the use of EAs. Benefits related largely to the efficacy of the aid in promoting erections. A wide range of drawbacks were also reported. CLINICAL IMPLICATIONS Given the negative sexual and psychological impacts associated with using EAs and finding them unhelpful, we suggest that researchers and health care providers should take care to proactively address potential challenges that are common with EA use, and also to consider the risks of failed attempts with EAs. STRENGTHS & LIMITATIONS By using both scaled and open-ended questions, a more nuanced picture of the relative benefits and limitations of EA use within the PCa population is presented. As responses were not mandatory, a subset of participants provided comments about the use of EAs. Additionally, the sample was quite homogenous, with mostly white, American and well-educated participants, so it therefore lacks generalizability to other populations. CONCLUSION This paper illustrates several challenges to EA use, while providing insight into reasons for abandonment of use of EAs. Walker LM, Sears CS, Santos-Iglesias P, et al. Hard Times: Prostate Cancer Patients' Experiences with Erectile Aids. J Sex Med 2021;18:1775-1787.
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Matthew AG, Trachtenberg LJ, Yang ZG, Robinson J, Petrella A, McLeod D, Walker L, Wassersug R, Elliott S, Ellis J, Jamnicky L, Fleshner N, Finelli A, Singal R, Brock G, Jarvi K, Bender J, Elterman D. An online Sexual Health and Rehabilitation eClinic (TrueNTH SHAReClinic) for prostate cancer patients: a feasibility study. Support Care Cancer 2021; 30:1253-1260. [PMID: 34463836 PMCID: PMC8407130 DOI: 10.1007/s00520-021-06510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
Purpose The primary objective was to determine the feasibility of implementing the TrueNTH SHAReClinic as a pan-Canadian sexual health and rehabilitation intervention for patients treated for localized prostate cancer. Methods The feasibility study was designed to evaluate the accessibility and acceptability of the intervention. Participants from five institutions across Canada were enrolled to attend one pre-treatment and five follow-up online clinic visits over 1 year following their prostate cancer (PC) treatment. Results Sixty-five patients were enrolled in the intervention. Website analytics revealed that 71% completed the intervention in its entirety, including the educational modules, with an additional 10% completing more than half of the intervention. Five thousand eighty-three views of the educational modules were made along with 654 views of the health library items. Over 1500 messages were exchanged between participants and their sexual health coaches. At 12 months, the intervention received an overall average participant rating of 4.1 out of 5 on a single item satisfaction measure. Conclusion Results support the TrueNTH SHAReClinic as highly acceptable to participants as defined by intervention adherence and engagement. The TrueNTH SHAReClinic demonstrated promise for being a feasible and potentially resource-efficient approach to effectively improving the sexual well-being of patients after PC treatment.
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Affiliation(s)
- A G Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Room 6-817, Toronto, ON, M5G 1Z6, Canada.
| | - L J Trachtenberg
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Room 6-817, Toronto, ON, M5G 1Z6, Canada
| | - Z G Yang
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Room 6-817, Toronto, ON, M5G 1Z6, Canada
| | - J Robinson
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - A Petrella
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Room 6-817, Toronto, ON, M5G 1Z6, Canada
| | - D McLeod
- Dalhousie University, Halifax, NS, Canada
| | - L Walker
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - R Wassersug
- Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - S Elliott
- Departments of Urologic Sciences, Vancouver Prostate Centre, Vancouver, BC, Canada
| | - J Ellis
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Jamnicky
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Room 6-817, Toronto, ON, M5G 1Z6, Canada
| | - N Fleshner
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Room 6-817, Toronto, ON, M5G 1Z6, Canada
| | - A Finelli
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 700 University Avenue, 6th Floor, Room 6-817, Toronto, ON, M5G 1Z6, Canada
| | - R Singal
- Toronto East Health Network Michael Garron Hospital, Toronto, ON, Canada
| | - G Brock
- Department of Surgery, Western University, London, ON, Canada
| | - K Jarvi
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - J Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - D Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
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Walker LM, Wiebe E, Turner J, Driga A, Andrews-Lepine E, Ayume A, Stephen J, Glaze S, Booker R, Doll C, Phan T, Brennan K, Robinson JW. The Oncology and Sexuality, Intimacy, and Survivorship Program Model: An Integrated, Multi-disciplinary Model of Sexual Health Care within Oncology. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:377-385. [PMID: 31797198 DOI: 10.1007/s13187-019-01641-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Cancer-related sexual dysfunction is documented as one of the most distressing and long-lasting survivorship concerns of cancer patients. Canadian cancer patients routinely report sexuality concerns and difficulty getting help. In response to this gap in care, clinical practice guidelines were recently published in the Journal of Clinical Oncology. A sweeping trend is the creation of specialized clinics for patients' sexual health concerns. However, this much-needed attempt to address this service gap can be difficult to sustain without addressing the cancer care system from a broader perspective. Herein, we describe the implementation of a tiered systemic model of cancer-related sexual health programming in a tertiary cancer center. This program follows the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model, used previously for guiding individual practitioners. Visually, the model resembles a pyramid. The top 2 levels, corresponding to Intensive Therapy and Specific Suggestions, are comprised of group-based interventions for common cancer-related sexual concerns and a multi-disciplinary clinic for patients with complex concerns. The bottom 2 levels, corresponding to Permission and Limited Information, consist of patient education and provider education and consultation services. We describe lessons learned during the development and implementation of this program, including the necessity for group-based services to prevent inundation of referrals to the specialized clinic, and the observation that creating specialized resources also increased the likelihood that providers would inquire about patients' sexual concerns. Such lessons suggest that successful sexual health programming requires services from a systemic approach to increase sustainability.
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Affiliation(s)
- Lauren M Walker
- University of Calgary, Calgary, AB, Canada.
- Tom Baker Cancer Centre, Calgary, AB, Canada.
| | - Ericka Wiebe
- University of Alberta, Edmonton, AB, Canada
- Cross Cancer Institute, Edmonton, AB, Canada
| | - Jill Turner
- University of Alberta, Edmonton, AB, Canada
- Cross Cancer Institute, Edmonton, AB, Canada
| | - Amy Driga
- University of Alberta, Edmonton, AB, Canada
- Cross Cancer Institute, Edmonton, AB, Canada
| | | | | | | | - Sarah Glaze
- University of Calgary, Calgary, AB, Canada
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | - Corinne Doll
- University of Calgary, Calgary, AB, Canada
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Tien Phan
- University of Calgary, Calgary, AB, Canada
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | - John W Robinson
- University of Calgary, Calgary, AB, Canada
- Tom Baker Cancer Centre, Calgary, AB, Canada
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Wibowo E, Wassersug RJ, Robinson JW, Santos-Iglesias P, Matthew A, McLeod DL, Walker LM. An Educational Program to Help Patients Manage Androgen Deprivation Therapy Side Effects: Feasibility, Acceptability, and Preliminary Outcomes. Am J Mens Health 2021; 14:1557988319898991. [PMID: 32024430 PMCID: PMC7005977 DOI: 10.1177/1557988319898991] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Androgen deprivation therapy (ADT), a common treatment for prostate cancer, is associated with physical, psychological, and sexual side effects that reduce patients' quality of life. The authors designed an educational program to prepare patients for managing these side effects. This paper describes an implementation model for national dissemination of the program, testing its feasibility and acceptability at the institutional and patient level. Postprogram changes in patients' self-efficacy to manage side effects and side effect bother are also explored. Patients on or anticipating ADT enrolled in the educational program. Pre and post intervention questionnaires measured patient satisfaction with the program, side effect bother, and self-efficacy to manage ADT side effects. The ADT Educational Program was deemed feasible and acceptable. Five of six targeted sites successfully launched the program with sufficient patient enrolment. Patient attendees were highly satisfied. Self-efficacy, bother, and use of management strategies were interrelated. Lower bother was associated with increased self-efficacy and more use of management strategies, and increased bother was associated with lower self-efficacy and less use of management strategies. Based on pre-post scores, improvements in patients' self-efficacy to manage ADT side effects were also observed. Results demonstrate that this brief educational program is feasible and acceptable to patients and cancer care institutions. The program appears to promote self-efficacy and the uptake of ADT management strategies for ADT side effects. The results of this study support the program implementation and suggest that improvements in self-efficacy after program participation may help patients adapt to ADT side effects.
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Affiliation(s)
| | | | | | | | | | - Deborah L McLeod
- Nova Scotia Health Authority, Halifax, Canada.,Dalhousie University, Halifax, NS, Canada
| | - Lauren M Walker
- University of Calgary, Alberta, Canada.,Arnie Charbonneau Cancer Institute, Calgary, AB, Canada
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Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples' Sexual Intimacy after Prostate Cancer: A Mixed Methods Approach. Sex Med 2021; 9:100310. [PMID: 33529815 PMCID: PMC8072164 DOI: 10.1016/j.esxm.2020.100310] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction Sexual health and intimacy are consistently reported among the top unmet supportive care needs of prostate cancer (PC) survivors. With an aging population and advances in PC detection and treatment, the need for better PC sexual health interventions is acute. Aim Examine the feasibility of a mindfulness-based therapy group aimed at improving sexual intimacy for couples following PC treatments. Methods A 4-session mindfulness-based group intervention was developed for PC survivors (mean age 65.6 yrs) and their partners (mean age 61.4 yrs). A mixed-methods approach was adopted to account for small sample sizes (N = 14 couples). Findings will guide future treatment refinement via participants’ lived experiences. Main Outcome Measures Quantitative outcomes assessed pretreatment, immediately after treatment, and 6 months later included relationship adjustment, sexual satisfaction, sexual function, depression, anxiety, and mindfulness. Qualitative outcomes used Grounded Theory Approach following posttreatment exit interviews. Results Effect sizes 6 months posttreatment indicated moderate improvements in overall sexual satisfaction and large increases in mindfulness in PC survivors, small decreases in sexual intimacy reported by partners, and small increases in anxiety in PC survivors and partners. Qualitative outcomes revealed 6 themes: (i) PC treatments must view PC as a couple’s disease; (ii) PC treatments must consider the impact of illness on individuals and the couple; (iii) Mindfulness was a valued treatment modality; (iv) Individual factors contribute to outcomes, and therefore, must be considered; (v) Multiple perceived mechanisms for change exist; (vi) Group format is a therapeutic element of the process. Conclusion An acceptance-based approach to sexual intimacy needs among PC survivors and their partners is feasible. While this small-scale preliminary study suggests that mindfulness may address some currently unmet needs among this population, randomized clinical trials are needed. JA Bossio, CS Higano, LA Brotto. Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples’ Sexual Intimacy after Prostate Cancer: A Mixed Methods Approach. Sex Med 2021;9:100310.
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10
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Walker LM. Psychosocial contributors to patients' and partners' postprostate cancer sexual recovery: 10 evidence-based and practical considerations. Int J Impot Res 2020; 33:464-472. [PMID: 33204005 DOI: 10.1038/s41443-020-00369-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 11/09/2022]
Abstract
Sexual recovery after prostate cancer (PCa) treatment is challenging. When expectations are that erectile response will quickly return to baseline, patients can often struggle when this does not happen. Further difficulty is experienced when patients encounter physical, psychological, and relational barriers to sexual adjustment. Drawing on the psychosocial research literature and on 15 years of clinical experience counseling PCa patients about sexual recovery, this paper outlines considerations for clinical practice. Suggestions include broadening the target for successful outcomes after Pca treatment beyond erectile function to include sexual distress and other sources of sexual concern. Clinicians are urged to consider individual differences such as the larger context of the patient, including their values and preferences, their treatment goals, and their relationship situation and status, in order to promote successful sexual adaptation. When introducing treatment approaches, the role of grief and loss should be assessed, and patients should be supported to foster realistic expectations about the recovery process. Suggestions for how to introduce various sexual strategies to patients are also offered, including ways to support patients in making and sustaining behavioral changes associated with sexual intervention. Clinicians are offered suggestions to promote patients' sexual flexibility, prevent long periods of sexual inactivity, and help patients to identify various sexual motivators. Consideration of these psychological, relational, and social factors are all likely to help facilitate better sexual outcomes for PCa patients.
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Affiliation(s)
- Lauren M Walker
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada. .,Division of PsychoOncology, Department of Oncology, University of Calgary, Calgary, AB, Canada. .,Department of Psychology, University of Calgary, Calgary, AB, Canada.
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Walker LM, Santos-Iglesias P. On the Relationship Between Erectile Function and Sexual Distress in Men with Prostate Cancer. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1575-1588. [PMID: 32072396 DOI: 10.1007/s10508-019-01603-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 06/10/2023]
Abstract
Erectile difficulties are common after prostate cancer (PCa) treatment and are associated with sexual distress. However, the relationship between erectile function and sexual distress has yet to be carefully examined. This study had three goals: (1) examine the relationship between erectile function and sexual distress; (2) determine groups of men based on erectile function and sexual distress; and (3) examine the psychosexual characteristics of these groups. A cross section of 233 sexually active men after PCa treatment (age M = 64.90 years, SD = 7.50) completed an online survey containing demographic, health, and sexuality and relationship questionnaires. The relationship between erectile function and sexual distress was curvilinear. Four groups of men were found: good erectile function and low sexual distress, poor erectile function and high sexual distress, but also good erectile function yet high sexual distress, and poor erectile function and low sexual distress. Regardless of erectile function, men with greater sexual distress were more depressed, reported additional sexual concerns, placed less value on sex, were less sexually satisfied, and used protective buffering communication more frequently. They were also less likely to be satisfied with their adaptation to sexual changes and less likely to have found a solution to those changes. The relationship between erectile function and sexual distress is complex, characterized by a wide array of responses to erectile function (high and low distress) and multiple correlates of sexual distress. These results broaden the concept of sexual recovery after PCa treatment, which may assist clinicians and researchers to better address sexual problems after PCa treatment.
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Affiliation(s)
- Lauren M Walker
- Tom Baker Cancer Centre-Holy Cross Site, Division of Psychosocial Oncology, Department of Oncology, University of Calgary, 2202 2nd Street SW, Calgary, AB, T2S 3C1, Canada.
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada.
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Smith A, Wittmann D, Saint Arnault D. The Ecology of Patients' Sexual Health Adjustment After Prostate Cancer Treatment: The Influence of the Social and Healthcare Environment. Oncol Nurs Forum 2020; 47:469-478. [PMID: 32555559 DOI: 10.1188/20.onf.469-478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Little empirical research identifies environmental influences on sexual recovery of men with prostate cancer. This secondary qualitative analysis aimed to describe the role of the patients' environment on their sexual recovery process following prostate cancer surgery. PARTICIPANTS & SETTING Transcripts of interviews with 8 heterosexual men were randomly selected and analyzed from a sample of 18 at three months postprostatectomy. METHODOLOGIC APPROACH The study was based on the social ecological model. Interpretative phenomenological analysis was applied to examine environmental factors affecting sexual recovery through the participant's perspective. FINDINGS The value of trusted connections and support extended beyond the partner to the patient's social and healthcare networks. IMPLICATIONS FOR NURSING These findings support the need for providers to assess the full constellation of patients' environmental experiences to better understand sexual recovery.
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Chung DY, Kim MS, Lee JS, Goh HJ, Koh DH, Jang WS, Hong CH, Choi YD. Clinical Significance of Multiparametric Magnetic Resonance Imaging as a Preoperative Predictor of Oncologic Outcome in Very Low-Risk Prostate Cancer. J Clin Med 2019; 8:jcm8040542. [PMID: 31010237 PMCID: PMC6518039 DOI: 10.3390/jcm8040542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/10/2019] [Accepted: 04/18/2019] [Indexed: 11/17/2022] Open
Abstract
Currently, multiparametric magnetic resonance imaging (mpMRI) is not an indication for patients with very low-risk prostate cancer. In this study, we aimed to evaluate the usefulness of mpMRI as a diagnostic tool in these patients. We retrospectively analyzed the clinical and pathological data of individuals with very low-risk prostate cancer, according to the NCCN guidelines, who underwent mpMRI before radical prostatectomy at our institution between 2010 and 2016. Patients who did not undergo pre-evaluation with mpMRI were excluded. We analyzed the factors associated with biochemical recurrence (BCR) using Cox regression model, logistic regression analysis, and Kaplan–Meier curve. Of 253 very low-risk prostate cancer patients, we observed 26 (10.3%) with BCR during the follow-up period in this study. The median follow-up from radical prostatectomy was 53 months (IQR 33–74). The multivariate Cox regression analyses demonstrated that the only factor associated with BCR in very low-risk patients was increase in the pathologic Gleason score (GS) (HR: 2.185, p-value 0.048). In addition, multivariate logistic analyses identified prostate specific antigen (PSA) (OR: 1.353, p-value 0.010), PSA density (OR: 1.160, p-value 0.013), and suspicious lesion on mpMRI (OR: 1.995, p-value 0.019) as the independent preoperative predictors associated with the pathologic GS upgrade. In our study, the pathologic GS upgrade after radical prostatectomy in very low-risk prostate cancer patients demonstrated a negative impact on BCR and mpMRI is a good prognostic tool to predict the pathologic GS upgrade. We believe that the implementation of mpMRI would be beneficial to determine the treatment strategy for these patients.
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Affiliation(s)
- Doo Yong Chung
- Department of Urology, Inha University School of Medicine, 366 Seohae-daero, Jung-gu, Incheon 22332, Korea.
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Min Seok Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Jong Soo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Hyeok Jun Goh
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Dong Hoon Koh
- Department of Urology, Konyang University College of Medicine, 158 Gwanjeodong-ro, Daejeon 35365, Korea.
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Chang Hee Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
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Elterman DS, Petrella AR, Walker LM, Van Asseldonk B, Jamnicky L, Brock GB, Elliott S, Finelli A, Gajewski JB, Jarvi KA, Robinson J, Ellis J, Shepherd S, Saadat H, Matthew A. Canadian consensus algorithm for erectile rehabilitation following prostate cancer treatment. Can Urol Assoc J 2018; 13:239-245. [PMID: 30526799 DOI: 10.5489/cuaj.5653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The present descriptive analysis carried out by a pan-Canadian panel of expert healthcare practitioners (HCPs) summarizes best practices for erectile rehabilitation following prostate cancer (PCa) treatment. This algorithm was designed to support an online sexual health and rehabilitation e-clinic (SHARe-Clinic), which provides biomedical guidance and supportive care to Canadian men recovering from PCa treatment. The implications of the algorithm may be used inform clinical practice in community settings. METHODS Men's sexual health experts convened for the TrueNTH Sexual Health and Rehabilitation Initiative Consensus Meeting to address concerns regarding erectile dysfunction (ED) therapy and management following treatment for PCa. The meeting brought together experts from across Canada for a discussion of current practices, latest evidence-based literature review, and patient interviews. RESULTS An algorithm for ED treatment following PCa treatment is presented that accounts for treatment received (surgery or radiation), degree of nerve-sparing, and level of pro-erectile treatment invasiveness based on patient and partner values. This algorithm provides an approach from both a biomedical and psychosocial focus that is tailored to the patient/partner presentation. Regular sexual activity is recommended, and the importance of partner involvement in the treatment decision-making process is highlighted, including the management of partner sexual concerns. CONCLUSIONS The algorithm proposed by expert consensus considers important factors like the type of PCa treatment, the timeline of erectile recovery, and patient values, with the goal of becoming a nationwide standard for erectile rehabilitation following PCa treatment.
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Affiliation(s)
- Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Anika R Petrella
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Lauren M Walker
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Leah Jamnicky
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Gerald B Brock
- Department of Surgery, St. Joseph's Hospital, London, ON, Canada
| | - Stacy Elliott
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Antonio Finelli
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Keith A Jarvi
- Murray Koffler Urologic Wellness Center, Mount Sinai Hospital, Toronto, ON, Canada
| | - John Robinson
- Clinical Psychology Department, University of Calgary, Calgary, AB, Canada
| | - Janet Ellis
- Department of Psychology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shaun Shepherd
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Hossein Saadat
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Andrew Matthew
- Division of Urology, University Health Network, Toronto, ON, Canada
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Novel Mapping Method for the Intraoperative Neurophysiologic Monitoring of Sexual Function During Prostate Surgery. J Clin Neurophysiol 2018; 35:463-467. [DOI: 10.1097/wnp.0000000000000506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kurian CJ, Leader AE, Thong MSY, Keith SW, Zeigler-Johnson CM. Examining relationships between age at diagnosis and health-related quality of life outcomes in prostate cancer survivors. BMC Public Health 2018; 18:1060. [PMID: 30139347 PMCID: PMC6108139 DOI: 10.1186/s12889-018-5976-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/16/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patient reports of health related quality of life can provide important information about the long-term impact of prostate cancer. Because patient symptoms and function can differ by age of the survivor, the aim of our study was to examine patient-reported quality of life and prostate symptoms by age at diagnosis among a registry of Dutch prostate cancer survivors. METHODS A population of 617 individuals from the Patient Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship (PROFILES) database was surveyed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) and prostate symptom (EORTC QLQ-PR25) scales. Age at diagnosis was the main independent variable, with three age categories: 60 years and younger, 61-70 years, and 71 years and older. Dependent variables were the EORTC-QLQ-C30 and EORTC QLQ-PR25 scales, divided into positive and negative outcomes. Positive measures of health-related quality of life included global health, physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning. Negative outcomes included fatigue, nausea, pain, dyspnea, insomnia, appetite, constipation, and diarrhea. We also assessed sexual activity, and urinary, bowel and hormonal symptoms. Descriptive analyses included frequencies with chi-square tests and medians with Kruskal-Wallis tests. Multivariable adjusted analyses were conducted by median regression modeling. RESULTS Among the numerous scales showing some unadjusted association with age group, only two scales demonstrated significant differences between prostate cancer patients age 71+ compared to the youngest group (age < 61) after multivariable adjustment. On average, the oldest patients experienced an 8.3-point lower median physical functioning score (β = - 8.3; 95% CI = - 13.9, - 2.8; p = 0.003) and a 16.7-point lower median sexual activity score (β = - 16.7; 95% CI = - 24.7, - 8.6; p < 0.001) while controlling for BMI, marital status, time since diagnosis, comorbidities (heart condition), Gleason score, and treatment (prostatectomy). CONCLUSIONS Results suggest that patient age at diagnosis should be considered among factors that contribute to health-related quality of life outcomes for prostate cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS A possible reevaluation of screening recommendations may be appropriate to acknowledge age as a factor contributing to health-related quality of life outcomes for prostate cancer survivors.
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Affiliation(s)
- Christine J Kurian
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amy E Leader
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Melissa S Y Thong
- Department of Medical Psychology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Charnita M Zeigler-Johnson
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
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Terrier JE, Masterson M, Mulhall JP, Nelson CJ. Decrease in Intercourse Satisfaction in Men Who Recover Erections After Radical Prostatectomy. J Sex Med 2018; 15:1133-1139. [PMID: 30033192 DOI: 10.1016/j.jsxm.2018.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/15/2018] [Accepted: 05/30/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Recovery of erections after radical prostatectomy (RP) is assumed to lead to recovery in sexual satisfaction. Although data suggest a relationship between sexual function and sexual satisfaction, it is unclear whether presurgical levels of sexual satisfaction are attained for men who "recover" erections post-RP. AIM The goal of this analysis is to determine whether the recovery of erectile function restores presurgical levels of sexual satisfaction. METHODS We assessed 229 men pre-RP and 24-months post-RP. At both time points, participants completed the Erectile Function Domain (EFD) and the Intercourse Satisfaction Domain (ISD) of the International Index of Erectile Function (IIEF). Erectile function recovery at 24 months was defined as (1) (EFD≥24) or (2) EFD back to baseline (BTB). One hundred sixty-six men with penetration hardness erections (PHEs) at baseline (EFD >24) were included in the analyses. Repeated measure t-tests were used to compare changes in ISD scores and effect size (Cohen's d) was calculated to determine the clinical significance of these changes. Multivariable analyses (MVA) were used to test the relationship between EFD and ISD. RESULTS The mean age of men was 58 (SD = 7) years. The mean EFD score at baseline was 29 (SD = 2), which declined significantly to 20 (SD = 10) at 24 months. ISD also decreased significantly between baseline and 24 months (12 to 8.3, P < .001, d = 0.87), even among men with PHEs at 24 months (12.3 to 11.3, P < .001, d = 0.50) and men who achieved BTB erections at 24 months (12.4 to 11.7, P = .02, d = 0.35). For men with PHEs at 24 months, MVAs identified baseline ISD (beta = 0.46) and 24-month EFD (beta = 0.23) as the only significant predictors of 24-month ISD. However, among men who achieved BTB erections at 24 months, baseline ISD (beta = 0.49) was the only significant predictor of 24-month ISD. CLINICAL IMPLICATIONS These findings underscore the importance of the integration of psychological support and medical care to best meet the needs of patients. Furthermore, these results can be used to facilitate pre-RP communication and counseling with patients to improve understanding and manage post-RP expectations. STRENGTHS & LIMITATIONS The study methodology, specifically the use of BTB as a means of defining erectile function and the longitudinal, prospective study design are relative strengths. Despite the longitudinal design, the study did not include a control group of healthy, age-matched men. CONCLUSION Results highlight the enduring impact of sexual dysfunction, namely erectile dysfunction, on intercourse satisfaction following RP and suggest that restoration of function in and of itself does not ensure the restoration of satisfaction. Terrier JE, Masterson M, Mulhall JP, et al. Decrease in intercourse satisfaction in men who recover erections after radical prostatectomy. J Sex Med 2018;15:1133-1139.
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Affiliation(s)
- Jean E Terrier
- Male Sexual and Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Melissa Masterson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Male Sexual and Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Gauvin S, Pukall CF. The SexFlex Scale: A Measure of Sexual Script Flexibility When Approaching Sexual Problems in a Relationship. JOURNAL OF SEX & MARITAL THERAPY 2018; 44:382-397. [PMID: 29166209 DOI: 10.1080/0092623x.2017.1405304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The objective of this paper was to develop a measure of sexual script flexibility when approaching a sexual problem in a relationship. A series of online studies were conducted with individuals in relationships. As one subscale on the two-factor model had poor convergent and discriminant validity, a final single factor scale with 6-items was retained. The single factor scale demonstrated good model fit, high internal reliability, adequate convergent and discriminant validity, and moderate test re-test reliability. These results support the SexFlex scale as a reliable and psychometrically sound assessment of an individual.s flexibility in approaching a sexual problem.
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Affiliation(s)
- S Gauvin
- a Department of Psychology , Queen's University , Kingston , Ontario , Canada
| | - C F Pukall
- a Department of Psychology , Queen's University , Kingston , Ontario , Canada
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Gilbert SM, Dunn RL, Miller DC, Montgomery JS, Skolarus TA, Weizer AZ, Wood DP, Hollenbeck BK. Functional Outcomes Following Nerve Sparing Prostatectomy Augmented with Seminal Vesicle Sparing Compared to Standard Nerve Sparing Prostatectomy: Results from a Randomized Controlled Trial. J Urol 2017; 198:600-607. [DOI: 10.1016/j.juro.2017.03.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Scott M. Gilbert
- Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Health Outcomes and Behavior Programs, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Rodney L. Dunn
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - David C. Miller
- Veterans Affairs Health Services Research and Development Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Jeffrey S. Montgomery
- Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Ted A. Skolarus
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
- Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Alon Z. Weizer
- Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | | | - Brent K. Hollenbeck
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
- Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan
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Matthew AG, Raz O, Currie KL, Louis AS, Jiang H, Davidson T, Fleshner NE, Finelli A, Trachtenberg J. Psychological distress and lifestyle disruption in low-risk prostate cancer patients: Comparison between active surveillance and radical prostatectomy. J Psychosoc Oncol 2017; 36:159-174. [DOI: 10.1080/07347332.2017.1342733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Andrew G. Matthew
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Orit Raz
- Department of Urology, Macquarie University Hospital, Sydney, Australia
| | - Kristen L. Currie
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Alyssa S. Louis
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Haiyan Jiang
- Department of Biostatistics, University Health Network, Toronto, ON, Canada
| | - Tal Davidson
- Department of Psychology, York University, Toronto, ON, Canada
| | - Neil E. Fleshner
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Antonio Finelli
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - John Trachtenberg
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
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Abstract
OBJECTIVE Prostate cancer is the most common type of male cancer in the United States and the negative effect of prostate cancer treatment on sexual function has been well documented. The objective of this study was to examine the long-term impact of sexual dysfunction on spouses or partners of prostate cancer survivors. METHODS A total of 742 spouses of prostate cancer survivors was mailed surveys by the Michigan Public Health Institute, of which 379 were returned (51%). Nine surveys were excluded owing to study ineligibility. Spouses responding to the survey completed a combination of modified items from the Sexual Adjustment Questionnaire and researcher-developed items. RESULTS Over 75% of spouses reported a decline in sex life quality after treatment. Communication about sexual issues between survivors and their health care providers was rated as good to excellent by 54.7% of partners, whereas 35.1% reported it as fair to poor. Approximately 60% of physicians initially recommended some form of sexual treatment. However, despite the persistence of sexual dysfunction, only 7% of the prostate cancer survivors were currently receiving treatment. Only 4.1% of health care providers referred the survivor to a sex therapist. CONCLUSIONS Physicians need to understand the importance of the open, ongoing communication with prostate cancer survivors about sexual issues because sexual dysfunction seems to continue indefinitely after completion of treatment. Research on the effectiveness of behavioral interventions in restoring sexual health is critically needed for this population, especially as first-line sexual aids and medications are often not satisfactory solutions.
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Walker LM, King N, Kwasny Z, Robinson JW. Intimacy after prostate cancer: A brief couples' workshop is associated with improvements in relationship satisfaction. Psychooncology 2016; 26:1336-1346. [PMID: 27197037 DOI: 10.1002/pon.4147] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 02/16/2016] [Accepted: 03/30/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Prostate cancer (PCa) treatments often leave men with erectile dysfunction (ED). Even when ED treatments are effective in restoring men's ability to have an erection sufficient for intercourse, couples continue to struggle sexually. Effective treatments to help couples recover sexually are needed. METHOD PCa patients and partners (N = 59 couples) attending a one-time couples' intimacy workshop, participated in an evaluation. The workshop, offered eight times over a 2-year period, emphasized a couples-based approach to treatment that enhances direct communication about sexuality and implementation of sexual recovery strategies that are consistent with the couple's values. Couples completed pre and post questionnaires (at baseline and 2 months later) assessing the primary outcome of relationship adjustment (Revised Dyadic Adjustment Scale) and secondary outcome of sexual function (Sexual Function Questionnaire). T-tests were employed to examine pre-post changes in scores. A small qualitative sub-study was conducted on the use of a Commitment to Change goal-setting exercise, completed during the workshop. RESULTS Results provide insight into the specific nature of improvements. Patients and partners showed improvements in relationship satisfaction. Improvements with small-to-medium effect sizes were observed for patients and partners sexual function; however, after adjusting for multiple comparisons, these changes were no longer statistically significant. The specific goals set by couples, and their achievement status, are presented. CONCLUSIONS The workshop offers a comprehensive, one-session intervention to help couples implement a treatment plan to promote sexual recovery after PCa treatment. Given the observed improvements, progression to a randomized control trial is warranted. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lauren M Walker
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Psychosocial & Rehabilitation Oncology, Calgary, AB, Canada
| | - Ngaire King
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Zoe Kwasny
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - John W Robinson
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Psychosocial & Rehabilitation Oncology, Calgary, AB, Canada.,Department of Psychology, University of Calgary, Calgary, AB, Canada
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Nagele E, Den Oudsten B, Greimel E. How to evaluate sexual health in cancer patients: development of the EORTC sexual health questionnaire for cancer patients. Transl Androl Urol 2016; 4:95-102. [PMID: 26816816 PMCID: PMC4708120 DOI: 10.3978/j.issn.2223-4683.2014.11.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background The aim of the study is to describe the development of a comprehensive European Organisation for Research and Treatment of Cancer (EORTC) questionnaire to assess sexual health of female and male cancer patients and for cancer survivors. Methods According to the EORTC guidelines, the development of an EORTC sexual health questionnaire is typically organised in four phases. The first phases comprise a literature search following interviews with patient and health care professionals (HCPs) (phase 1) and the operationalization into items (phase 2). The translation process is formally conducted according to the EORTC QLG Translation guidelines with a rigorous forward-backward procedure supported by native speakers. Results Studies on sexuality in oncology patients which were identified by a literature search predominantly focused on issues of activity, experiences of sexual dysfunction, and satisfaction with sexual functioning. The literature review identified themes beyond these aspects. In total 53 potentially relevant issues were presented to 107 patients and 83 HCPs, different evaluations were found. Conclusions A questionnaire that includes physical, psychological, and social aspects of sexuality of cancer survivors will be needed. Pre-testing and validation of the questionnaire will be done in future (phases 3 and 4). Divergent ratings of patients and professionals should be further investigated.
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Affiliation(s)
- Eva Nagele
- 1 Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria ; 2 Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Brenda Den Oudsten
- 1 Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria ; 2 Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Elfriede Greimel
- 1 Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria ; 2 Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
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Salonia A, Castagna G, Capogrosso P, Castiglione F, Briganti A, Montorsi F. Prevention and management of post prostatectomy erectile dysfunction. Transl Androl Urol 2016; 4:421-37. [PMID: 26816841 PMCID: PMC4708594 DOI: 10.3978/j.issn.2223-4683.2013.09.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Sexual dysfunction is common in patients with prostate cancer (PC) following radical prostatectomy (RP). Review the available literature concerning prevention and management strategies for post-RP erectile function (EF) impairment in terms of preoperative patient characteristics, intra and postoperative factors that may influence EF recovery, and postoperative treatments for erectile dysfunction (ED). A literature search was performed using Google and PubMed database for English-language original and review articles, either published or e-published up to July 2013. The literature still demonstrates a great inconsistency in the definition of what is considered normal EF both before and after RP. Thus, using validated psychometric instruments with recognized cut-offs for normalcy and severity during the pre- and post-operative evaluation should be routinely considered. Therefore, a comprehensive discussion with the patient about the true prevalence of postoperative ED, the concept of spontaneous or pharmacologically-assisted erections, and the difference between “back to baseline” EF and “erections adequate enough to have successful intercourse” clearly emerge as key issues in the eventual understanding of post-RP ED prevention and promotion of satisfactory EF recovery. Patient factors (including age, baseline EF, comorbid conditions status), cancer selection (non- vs. uni- vs. bilateral nerve-sparing), type of surgery (i.e., intra vs. inter vs. extrafascial surgeries), surgical techniques (i.e., open, laparoscopic and robotically-assisted RP), and surgeon factors (i.e., surgical volume and surgical skill) represent the key significant contributors to EF recovery. A number of preclinical and clinical data show that rehabilitation and treatment in due time are undoubtedly better than leaving the erectile tissue to its unassisted postoperative fate. The role of postoperative ED treatment for those patients who received a non-nerve-sparing RP was also extensively discussed. Optimal outcomes are achieved mainly by the careful choice of the correct patient for the correct type of surgery. Despite a plethora of potential rehabilitative approaches, they should be only considered as “strategies”, since incontrovertible evidence of their effectiveness for improving natural EF recovery is limited. Conversely, numerous effective therapeutic options are available for treating post-RP ED.
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Affiliation(s)
- Andrea Salonia
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Giulia Castagna
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Paolo Capogrosso
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Fabio Castiglione
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Alberto Briganti
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Francesco Montorsi
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
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Culha MG, Pastuszak A, Serefoglu EC. Re: Effect of Tadalafil Once Daily on Penile Length Loss and Morning Erections in Patients After Bilateral Nerve-sparing Radical Prostatectomy: Results From a Randomized Controlled Trial (Urology 2015;85:1090-1096). Urology 2015; 86:1242-3. [PMID: 26404057 DOI: 10.1016/j.urology.2015.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Mehmet Gokhan Culha
- Department of Urology Istanbul Training and Research Hospital Istanbul, Turkey
| | - Alexander Pastuszak
- Department of Urology Bağcilar Training and Research Hospital Istanbul, Turkey
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Østby-Deglum M, Brennhovd B, Axcrona K, Fosså SD, Dahl AA. A comparative study of erectile function and use of erectile aids in high-risk prostate cancer patients after robot-assisted laparoscopic prostatectomy. Scand J Urol 2015; 49:433-439. [DOI: 10.3109/21681805.2015.1042038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
Many therapies for erectile dysfunction (ED) after prostate cancer treatment improve erectile firmness, yet, most couples stop using aids within 1-2 years. Patients and partners who expect immediate and complete success with their first ED treatment can be demoralized when they experience treatment failure, which contributes to reticence to explore other ED aids. Comprehensive patient education should improve sustainability and satisfaction with ED treatments. Pre-emptive and realistic information should be provided to couples about the probability of recovering natural erections. Beginning intervention early and using a couple-based approach is ideal. Recommendations are provided about the timing of ED treatment, the order of aid introduction, and combination therapies. Renegotiation of sexual activity is an essential part of sexual adaptation. From the outset of therapy, couples should be encouraged to broaden their sexual repertoire, incorporate erection-independent sexual activities, and continue to be sexual despite ED and reduced libido.
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Santa Mina D, Matthew AG, Hilton WJ, Au D, Awasthi R, Alibhai SMH, Clarke H, Ritvo P, Trachtenberg J, Fleshner NE, Finelli A, Wijeysundera D, Aprikian A, Tanguay S, Carli F. Prehabilitation for men undergoing radical prostatectomy: a multi-centre, pilot randomized controlled trial. BMC Surg 2014; 14:89. [PMID: 25394949 PMCID: PMC4246547 DOI: 10.1186/1471-2482-14-89] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 10/02/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND An emerging field of research describes the role of preoperative health behaviours, known as prehabilitation. The preoperative period may be a more physically and emotionally salient time to introduce and foster chronic adherence to health behaviours, such as exercise, in patients compared to post-treatment during recovery. Moreover, physical and psychosocial improvements during the preoperative period may translate into an enhanced recovery trajectory with reduced operative complications and postoperative adverse effects. No studies have assessed prehabilitation for men with prostate cancer undergoing radical prostatectomy. METHODS/DESIGN This is a multi-centre, pilot randomized control trial conducted at two Canadian urban teaching hospitals. 100 men undergoing radical prostatectomy for prostate cancer with no contraindications to exercise will be recruited and randomized to the prehabiliation program or usual care. Prehabilitation participants will engage in a preoperative, individualized exercise program including pelvic floor muscle strengthening instructions and a healthy lifestyle guide for men with prostate cancer. These participants will be asked to engage in 60 minutes of home-based, unsupervised, moderate-intensity exercise on 3-4 days per week. Usual care participants will receive the same pelvic floor muscle strengthening instructions and healthy lifestyle guide only. We will assess the feasibility of conducting an adequately powered trial of the same design via recruitment rate, programmatic adherence/contamination, attrition, and safety. Estimates of intervention efficacy will be captured through measurements at baseline (4-8 weeks preoperatively), within 1 week prior to surgery, and postoperatively at 4, 12, and 26 weeks. Efficacy outcomes include: fatigue, quality of life, urinary incontinence, physical fitness, body composition, aerobic fitness, pain, and physical activity volume. DISCUSSION The primary outcome of this study is to determine the feasibility of conducting a full-scale, randomized controlled trial of prehabilitation versus usual care and to estimate effect sizes that will inform sample size determinations for subsequent trials in this field. To our knowledge, this is the first study to examine a structured presurgical exercise program for men undergoing radical prostatectomy for prostate cancer. This trial will advance our understanding of strategies to efficiently and effectively use the preoperative period to optimize postoperative recovery. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02036684.
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Affiliation(s)
- Daniel Santa Mina
- />Kinesiology Program, University of Guelph-Humber, Toronto, ON Canada
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Guelph, Guelph, ON Canada
| | - Andrew G Matthew
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - William J Hilton
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Guelph, Guelph, ON Canada
| | - Darren Au
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Guelph, Guelph, ON Canada
| | | | - Shabbir MH Alibhai
- />University of Toronto, Toronto, ON Canada
- />University Health Network, Toronto, ON Canada
| | - Hance Clarke
- />University of Toronto, Toronto, ON Canada
- />University Health Network, Toronto, ON Canada
| | - Paul Ritvo
- />Kinesiology and Health Sciences Department, York University, Toronto, ON Canada
- />Cancer Care Ontario, Toronto, ON Canada
| | - John Trachtenberg
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - Neil E Fleshner
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - Antonio Finelli
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - Duminda Wijeysundera
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | | | - Simon Tanguay
- />McGill University Health Centre, Montreal, QC Canada
| | - Franco Carli
- />McGill University Health Centre, Montreal, QC Canada
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Bozkurt IH, Arslan B, Kozacioglu Z, Yonguc T, Degirmenci T, Gunlusoy B, Minareci S. Does the etiology affect the outcome and satisfaction rates of penile prosthesis implantation surgery? Kaohsiung J Med Sci 2014; 30:570-3. [DOI: 10.1016/j.kjms.2014.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/08/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022] Open
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Plym A, Folkvaljon Y, Garmo H, Holmberg L, Johansson E, Fransson P, Stattin P, Lambe M. Drug Prescription for Erectile Dysfunction Before and After Diagnosis of Localized Prostate Cancer. J Sex Med 2014; 11:2100-8. [DOI: 10.1111/jsm.12586] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Isgoren AE, Saitz TR, Serefoglu EC. Erectile Function Outcomes after Robot‐Assisted Radical Prostatectomy: Is It Superior to Open Retropubic or Laparoscopic Approach? Sex Med Rev 2014; 2:10-23. [DOI: 10.1002/smrj.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Hartman ME, Irvine J, Currie KL, Ritvo P, Trachtenberg L, Louis A, Trachtenberg J, Jamnicky L, Matthew AG. Exploring gay couples' experience with sexual dysfunction after radical prostatectomy: a qualitative study. JOURNAL OF SEX & MARITAL THERAPY 2013; 40:233-253. [PMID: 23899045 DOI: 10.1080/0092623x.2012.726697] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This exploratory study examines the experience of three gay couples managing sexual dysfunction as a result of undergoing a radical prostatectomy. Semi-structured interviews were conducted as part of a larger study at an urban hospital in Toronto, Ontario, Canada. Interview transcripts were transcribed verbatim, and analyzed using interpretative phenomenological analysis. The authors clustered 18 subordinate themes under 3 superordinate themes: (a) acknowledging change in sexual experience (libido, erectile function, sexual activity, orgasmic function); (b) accommodating change in sexual experience (strategies: emphasizing intimacy, embracing plan B, focus on the other; barriers: side-effect concerns, loss of naturalness, communication breakdown, failure to initiate, trial and failure, partner confounds); and (c) accepting change in sexual experience (indicators: emphasizing health, age attributions, finding a new normal; barriers: uncertain outcomes, treatment regrets). Although gay couples and heterosexual couples share many similar challenges, we discovered that gay men have particular sexual roles and can engage in novel accommodation practices, such as open relationships, that have not been noted in heterosexual couples. All couples, regardless of their level of sexual functioning, highlighted the need for more extensive programming related to sexual rehabilitation. Equitable rehabilitative support is critical to assist homosexual couples manage distress associated with prostatectomy-related sexual dysfunction.
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Affiliation(s)
- Mary-Ellen Hartman
- a Department of Surgical Oncology, Princess Margaret Cancer Centre , University Health Network , Toronto , Ontario , Canada
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Close A, Robertson C, Rushton S, Shirley M, Vale L, Ramsay C, Pickard R. Comparative cost-effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of men with localised prostate cancer: a health technology assessment from the perspective of the UK National Health Service. Eur Urol 2013; 64:361-9. [PMID: 23498062 DOI: 10.1016/j.eururo.2013.02.040] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/25/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Robot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs. OBJECTIVE To determine the cost-effectiveness of robotic prostatectomy. DESIGN, SETTING, AND PARTICIPANTS We conducted a care pathway description and model-based cost-utility analysis. We studied men with localised prostate cancer able to undergo either robotic or laparoscopic prostatectomy for cure. We used data from a meta-analysis, other published literature, and costs from the UK National Health Service and commercial sources. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Care received by men for 10 yr following radical prostatectomy was modelled. Clinical events, their effect on quality of life, and associated costs were synthesised assuming 200 procedures were performed annually. RESULTS AND LIMITATIONS Over 10 yr, robotic prostatectomy was on average (95% confidence interval [CI]) £1412 (€1595) (£1304 [€1473] to £1516 [€1713]) more costly than laparoscopic prostatectomy but more effective with mean (95% CI) gain in quality-adjusted life-years (QALYs) of 0.08 (0.01-0.15). The incremental cost-effectiveness ratio (ICER) was £18 329 (€20 708) with an 80% probability that robotic prostatectomy was cost effective at a threshold of £30 000 (€33 894)/QALY. The ICER was sensitive to the throughput of cases and the relative positive margin rate favouring robotic prostatectomy. CONCLUSIONS Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin, provided >150 cases are performed each year. Considerable uncertainty persists in the absence of directly comparative randomised data.
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Affiliation(s)
- Andrew Close
- School of Biology, Newcastle University, Newcastle upon Tyne, UK
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Tutolo M, Briganti A, Suardi N, Gallina A, Abdollah F, Capitanio U, Bianchi M, Passoni N, Nini A, Fossati N, Rigatti P, Montorsi F. Optimizing postoperative sexual function after radical prostatectomy. Ther Adv Urol 2012; 4:347-65. [PMID: 23205061 PMCID: PMC3491757 DOI: 10.1177/1756287212450063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Erectile dysfunction (ED) is one of the complications associated with pelvic surgery. The significance of ED as a complication following pelvic surgery, especially radical prostatectomy (RP), lies in the negative impact that it has on patients' sexual and overall life. In the literature, rates of ED following RP range from 25% to 100%. Such variety is associated with pelvic dissection and conservation of neurovascular structures. Another important factor impacting on postoperative ED is the preoperative erectile function of the patient. Advances in the knowledge of pelvic anatomy and pathological mechanisms led to a refinement of pelvic surgical techniques, with attention to the main structures that if damaged compromise erectile function. These improvements resulted in lower postoperative ED rates and better erectile recovery, especially in patients undergoing RP. Furthermore, surgery alone is not sufficient to prevent this complication, and thus, several medical strategies have been tested with the aim of maximizing erectile function recovery. Indeed it seems that prevention of postoperative ED must be addressed by a multimodal approach. The aim of this review is to give a picture of recent knowledge, novel techniques and therapeutic approaches in order to reach the best combination of treatments to reduce the rate of ED after pelvic surgery.
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Affiliation(s)
- Manuela Tutolo
- Department of Urology, Vita Salute University, Urological Research Institute, San Raffaele Hospital, Milan, Italy
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Namiki S, Ishidoya S, Nakagawa H, Ito A, Kaiho Y, Tochigi T, Takegami M, Arai Y. The Relationships Between Preoperative Sexual Desire and Quality of Life Following Radical Prostatectomy: A 5‐Year Follow‐Up Study. J Sex Med 2012; 9:2448-56. [DOI: 10.1111/j.1743-6109.2012.02788.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rouprêt M, Seisen T, De La Taille A, Desgrandchamps F. Troubles sexuels associés aux maladies de la prostate. Prog Urol 2012; 22 Suppl 1:S14-20. [DOI: 10.1016/s1166-7087(12)70030-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Salonia A, Burnett AL, Graefen M, Hatzimouratidis K, Montorsi F, Mulhall JP, Stief C. Prevention and management of postprostatectomy sexual dysfunctions part 2: recovery and preservation of erectile function, sexual desire, and orgasmic function. Eur Urol 2012; 62:273-86. [PMID: 22575910 DOI: 10.1016/j.eururo.2012.04.047] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/23/2012] [Indexed: 01/07/2023]
Abstract
CONTEXT Sexual dysfunction is common in patients who undergo radical prostatectomy (RP) for prostate cancer (PCa). OBJECTIVE Review the available literature concerning prevention of, and management strategies for, post-RP sexual dysfunction in terms of postoperative treatments for erectile function (EF), sexual desire (SD), and orgasmic function (OF) impairment. EVIDENCE ACQUISITION A literature search was performed using Google and PubMed databases for English language original and review articles either published or e-published up to November 2011. EVIDENCE SYNTHESIS We propose a rational description of many of the clinically available preventive and therapeutic strategies for the preservation and recovery of post-RP EF. A huge amount of preclinical data show that tissue damage ultimately leads to structural alterations, and the literature stresses that rehabilitation and treatment are undoubtedly better than leaving the erectile tissue to its unassisted fate; likewise, the timing of any rehabilitation and treatment is of major clinical importance. However, no specific recommendation emerges regarding the structure of the optimal rehabilitation or treatment regimen. The role of postoperative erectile dysfunction (ED) treatment of those patients who received a non-nerve-sparing RP was also extensively discussed. The literature almost completely lacks a systematic and comprehensive debate about SD (ie, low libido) and OF (ie, decreased intensity of orgasm, dysorgasmia, and climacturia) in patients undergoing RP. Psychological and sexual counseling is of major importance to improve any rehabilitation and treatment of postoperative EF, SD, and OF impairment. CONCLUSIONS Despite the great number of possible rehabilitation approaches proposed, these approaches should be considered only as strategies, since incontrovertible evidence of their effectiveness for improving natural EF recovery is limited. Conversely, numerous effective therapeutic options are available for treating post-RP ED. SD and OF have not yet been fully assessed in patients who underwent RP.
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Affiliation(s)
- Andrea Salonia
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
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Effects of early pelvic-floor muscle exercise for sexual dysfunction in radical prostatectomy recipients. Cancer Nurs 2012; 35:106-14. [PMID: 21915042 DOI: 10.1097/ncc.0b013e3182277425] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexual dysfunction is common after radical prostatectomy (RP). Although pelvic-floor muscle exercise (PFME) has been recommended for sexual dysfunction, the optimal time for starting exercises after this surgery and the effects of exercise still need to be examined. OBJECTIVES The present study was intended to explore the prevalence of sexual dysfunction and to assess the efficacy of PFME in sexual dysfunction following RP. METHODS Participants were randomly distributed into an experimental group (n = 35) or a control group (n = 27). The experimental group took part in PFME as part of regular daily activities after catheter removal post-RP. The control group was taught the exercise in the third month after RP. We followed up the participants at 1, 3, 6, 9, and 12 months. RESULTS All of the patients experienced a severe degree of sexual dysfunction after receiving RP. A t test showed a significant difference in the sexual function mean score between the experimental and control groups at 6 and 12 months. A mixed-model analysis indicated that, after a controlled surgical approach, there was a significant difference in group effect. The experimental group's sexual function was better than the control group's sexual function. CONCLUSION This study demonstrates that early PFME is an effective intervention for sexual dysfunction in prostatectomy patients. The results can help healthcare providers to include this intervention in patients' discharge plans. IMPLICATIONS FOR PRACTICE Patient sexual dysfunction after an RP is common. Nurses should evaluate and manage patients' sexual dysfunction and promote the early return of patients' potency.
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Davison BJ, Matthew A, Elliott S, Breckon E, Griffin S. Assessing couples' preferences for postoperative sexual rehabilitation before radical prostatectomy. BJU Int 2012; 110:1529-35. [PMID: 22443321 DOI: 10.1111/j.1464-410x.2012.11083.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the readiness of couples to engage in a sexual rehabilitation programme (SRP) before radical prostatectomy (RP) and to identify barriers to participation in an SRP after RP. To identify couples' current levels of sexual function and intimacy. PATIENTS AND METHODS Patients completed the International Index of Erectile Function (IIEF) and their partners completed the Female Sexual Function Index (FSFI) to measure sexual function. Couples completed the Miller Social Intimacy Scale (MSIS) to measure intimacy in relationships. All participants were seen by a sexual health clinician after completing the measures to discuss barriers to participation in an SRP, and to receive an education session. RESULTS Study participants comprised 143 patients and 104 partners. Patients <60 years old had significantly higher sexual function (P < 0.002) compared with those patients aged 60 years and older. Partners' sexual function scores were suggestive of need for further medical evaluation. Partners' participation was cited by patients as important to them enrolling in an SRP. Couples' intimacy levels were strongly correlated (P < 0.0001). CONCLUSIONS Results suggest that less than 50% of patients are interested in receiving information about the impact of RP on sexual function before surgery. Female sexual function should be assessed as part of any SRP because they may require medical treatment if they are to support rehabilitation efforts for their spouses. Baseline assessment of a couple's sexual function and willingness to participate in an SRP should be performed preoperatively.
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Affiliation(s)
- B Joyce Davison
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.
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Smyth LG, Cullen IM, Quinlan DM. Pursuit of sexual function post-radical prostatectomy. Can Urol Assoc J 2012; 7:E183-9. [PMID: 22277629 DOI: 10.5489/cuaj.10192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- Lisa G Smyth
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Ivor M Cullen
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - David M Quinlan
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
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Casey RG, Corcoran NM, Goldenberg SL. Quality of life issues in men undergoing androgen deprivation therapy: a review. Asian J Androl 2012; 14:226-31. [PMID: 22231296 DOI: 10.1038/aja.2011.108] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Androgen deprivation therapy (ADT) has been an essential treatment option for treating prostate cancer (PCa). The role for hormonal treatment initially was restricted to men with metastatic and inoperable, locally advanced disease. Now it has been extended to neoadjuvant or adjuvant therapy for surgery and radiotherapy, for biochemical relapse after surgery or radiation, and even as primary therapy for non-metastatic disease. Fifty percent of PCa patients treated will receive ADT at some point. There is growing concern about the adverse effects and costs associated with more widespread ADT use. The adverse effects on quality of life (QoL), including physical, social and psychological well-being when men are androgen-deprived, may be considerable. This review examines the QoL issues in the following areas: body feminisation, sexual changes, relationship changes, cognitive and affective symptoms, fatigue, sleep disturbance, depression and physical effects. Further suggestions for therapeutic approaches to reduce these alterations are suggested.
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Affiliation(s)
- Rowan G Casey
- University of British Columbia Department of Urologic Sciences, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada.
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42
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Lin YH, Lin VCH, Yu TJ, Chen TB, Yang MS, Kao CC. The effects of a nerve-sparing procedure on urinary incontinence and sexual function among radical prostatectomy patients. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2011. [DOI: 10.1111/j.1749-771x.2011.01131.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mohamed NE, Bovbjerg DH, Montgomery GH, Hall SJ, Diefenbach MA. Pretreatment depressive symptoms and treatment modality predict post-treatment disease-specific quality of life among patients with localized prostate cancer. Urol Oncol 2011; 30:804-12. [PMID: 21795078 DOI: 10.1016/j.urolonc.2011.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 01/26/2011] [Accepted: 02/06/2011] [Indexed: 11/15/2022]
Abstract
PURPOSE This study examines the prevalence of depressive symptoms before prostate cancer treatment and explores associations among pre-treatment depressive symptoms and post-treatment disease-specific QOL, controlling for treatment modality, and demographic and clinical covariates. MATERIALS AND METHODS A case series of patients diagnosed with localized prostate cancer (T1-2N0M0) at a comprehensive cancer center was assessed. Of the 1,370 eligible patients, 869 (63.34%) completed questionnaires at diagnosis (baseline) and 6 months following treatment. Patients were treated with surgery (16.8%), brachytherapy (27.6%), or external beam radiation (EBRT; 55.6%). Depressive symptoms and disease-specific QOL were assessed with established measures (i.e., Center for Epidemiologic Studies Depression Scale (CES-D); sexual adjustment questionnaire (SAQ); and the American Urological Association symptom index). RESULTS A fifth of the sample (19.7%) reported clinically elevated levels of depressive symptoms at baseline. The proportion of clinically elevated levels of baseline depressive symptoms was higher among surgery patients compared with patients treated with brachytherapy or external beam radiation. Depressive symptoms at baseline and treatment modality significantly predicted sexual and urinary dysfunction, related bother, activity limitation due to urinary dysfunction at 6 months, controlling for, age, PSA level, Gleason score, relevant baseline indicators of sexual and urinary dysfunction, related bother, and activity limitation (P < 0.05). CONCLUSIONS Pretreatment depressive symptoms and treatment modality predict QOL after PrCa treatment. Health care providers should be sensitive to the display of depressive symptoms before PrCa treatment and consider preventative interventions, including preparing patients for the changes in disease-specific QOL and related bother following prostate cancer treatment.
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Affiliation(s)
- Nihal E Mohamed
- Department of Urology, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Matthew AG, Currie KL, Ritvo P, Nam R, Nesbitt ME, Kalnin RW, Trachtenberg J. Personal digital assistant data capture: the future of quality of life measurement in prostate cancer treatment. J Oncol Pract 2011; 3:115-20. [PMID: 20859395 DOI: 10.1200/jop.0732001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This article examines the potential use of personal digital assistant (PDA) data capture systems for real-time linear monitoring of health-related quality of life (HRQOL) in prostate cancer research and clinical care. METHODS We discuss the benefits and potential issues of using PDA data capture in the clinical health care setting. In addition, we describe the development and potential use of a PDA data capture system specific to managing HRQOL in prostate cancer treatment. CONCLUSION Follow-up health care clinics require a practical and systematic process of HRQOL data capture and analysis. Traditional paper questionnaire data capture is problematic. Data manipulation required for clinical decision-making is impractical for patient feedback on same-day clinic visits. Furthermore, the process of transforming paper questionnaire data to analysis-quality data can compromise data integrity. In contrast, research findings confirm the acceptability, ease of use, and reliability of PDAs in capturing data across health care settings, including the collection of serial HRQOL data. The main concern for PDA capture systems is the ability to compare respondent's answers between the paper and PDA questionnaire. Other challenges included patients reporting a lack of computer literacy and/or poor eyesight, as well as initial start-up costs. If issues are successfully addressed, the use of a PDA data capture system, such as the PDA HRQOL system at Princess Margaret Hospital's Prostate Centre, allows for valid and economical data collection with the possibility of linear real-time measurement of changes in HRQOL. Accordingly, there appears to be significant potential for PDA data collection of serial HRQOL in prostate cancer clinic settings.
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Affiliation(s)
- Andrew G Matthew
- The Prostate Centre, Princess Margaret Hospital, University Health Network; University of Toronto; York University; Cancer Care Ontario; Ontario Cancer Institute; Toronto General Research Institute, University Health Network; Sunnybrook Health Sciences Centre; Meridian Software Development, Toronto, Ontario, Canada
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Tal R, Jacks LM, Elkin E, Mulhall JP. Penile Implant Utilization Following Treatment for Prostate Cancer: Analysis of the SEER-Medicare Database. J Sex Med 2011; 8:1797-804. [DOI: 10.1111/j.1743-6109.2011.02240.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Erectile dysfunction and sexual health after radical prostatectomy: impact of sexual motivation. Int J Impot Res 2011; 23:81-6. [PMID: 21471982 DOI: 10.1038/ijir.2011.8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The life expectancy of patients with localized prostate cancer at treatment initiation has increased, and post-treatment quality of life has become a key issue. The aim of this study is to assess the impact of Radical prostatectomy (RP) on patients' sexual health and satisfaction according to sexual motivation using a self-administered questionnaire completed by two groups of RP patients, with high or lower levels of sexual motivation. A total of 63 consecutive patients were included (mean age, 63.9 years), of whom 74.6% were being treated for erectile dysfunction (ED). After RP, patients reported lower sexual desire (52.4%), reduced intercourse frequency (79.4%), anorgasmia (39.7%), less satisfying orgasm (38.1%), climacturia (25.4%), greater distress (68.3%) and/or lower partner satisfaction (56.5%). Among the most sexually motivated patients, 76.0% reported loss of masculine identity, 52% loss of self-esteem and 36.0% anxiety about performance. These rates were lower among less motivated patients (52.6, 28.9, and 18.4%, respectively). Mean overall satisfaction score was 4.8 ± 2.9. The score was significantly lowered in motivated than less motivated patients (3.4 vs 5.8) (P = 0.001). In conclusion, RP adversely affected erectile and orgasmic functions but also sexual desire, self-esteem and masculinity. The more motivated patients experienced greater distress and were less satisfied.
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Briganti A, Gallina A, Suardi N, Capitanio U, Tutolo M, Bianchi M, Salonia A, Colombo R, Di Girolamo V, Martinez‐Salamanca JI, Guazzoni G, Rigatti P, Montorsi F. What Is the Definition of a Satisfactory Erectile Function After Bilateral Nerve Sparing Radical Prostatectomy? J Sex Med 2011; 8:1210-7. [DOI: 10.1111/j.1743-6109.2010.02179.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Zermann DH. [The patient after radical prostatectomy: complexity and efficiency of a urological rehabilitation program]. Urologe A 2011; 50:425-32. [PMID: 21424425 DOI: 10.1007/s00120-010-2481-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Timely physical and mental convalescence and an early recovery of functional side effects belong to an efficient treatment concept for prostate cancer. Every prostate cancer patient has a right to take part in a urological rehabilitation program (Germany). The objectives are continence, potency, overcoming physical complaints, reduction of health risk factors, and psychological support. The results presented show the complexity and efficiency of a urological rehabilitation program.
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Affiliation(s)
- D-H Zermann
- Fachabteilung für Urologie, Uroonkologie & Nephrologie, Vogtland-Klinik Bad Elster, Forststraße 3, 08645 Bad Elster, Deutschland.
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Messaoudi R, Menard J, Parquet H, Ripert T, Staerman F. [Modification of sexual desire and orgasm after radical prostatectomy for prostate cancer]. Prog Urol 2010; 21:48-52. [PMID: 21193145 DOI: 10.1016/j.purol.2010.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 07/15/2010] [Accepted: 07/31/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess the impact of RP on patients' sexual desire and orgasm. MATERIAL AND METHODS Prospective, cross-sectional survey using a 16-item self-administered questionnaire. We assessed relevant domains of male sexual function (erectile function, sexual desire, and orgasm), psychological impact and treatment of ED. RESULTS A total of 63 consecutive patients after RP were included (mean age: 63.9). Median time between questionnaire and RP was 26.8 months (range 6-67). After RP, 74.6 % of patients used ED treatments. Lower sexual desire and intercourse frequency were reported in respectively 52.4 and 79.4 %. Orgasm was modified in most patients: 39.7 % described loss of orgasm and 38.1 % reported decreased intensity. Involuntary loss of urine at orgasm (climacturia) was reported in 25.4 %. Negative psychological impact was reported in 68.3 % (loss of self-esteem, loss of masculinity, anxiety). CONCLUSIONS RP adversely affected erectile and orgasmic functions but also sexual desire, self-esteem and masculinity despite treatments. Candidates for RP should be aware of ED but also of other postoperative sexual dysfunctions.
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Affiliation(s)
- R Messaoudi
- Département d'urologie-andrologie, CHU Robert-Debré, avenue du Général-Koenig, 51100 Reims, France.
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Le JD, Cooperberg MR, Sadetsky N, Hittelman AB, Meng MV, Cowan JE, Latini DM, Carroll PR. Changes in specific domains of sexual function and sexual bother after radical prostatectomy. BJU Int 2010; 106:1022-9. [DOI: 10.1111/j.1464-410x.2010.09231.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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