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Al Demour S, Adwan S, Jafar H, Alhawari H, Awidi A. Stem cell therapy in diabetic men with erectile dysfunction: a 24-month follow-up of safety and efficacy of two intracavernous autologous bone marrow derived mesenchymal stem cells injections, an open label phase 2 clinical trial. Basic Clin Androl 2024; 34:13. [PMID: 38965462 PMCID: PMC11225209 DOI: 10.1186/s12610-024-00229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/29/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Recently we reported results of phase 1 pilot clinical trial of 2 consecutive intracavernous (IC) injection of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) for the first time in the treatment of diabetic patients with erectile dysfunction (DM-ED). In phase 2 of this study our aim is to evaluate long term safety and efficacy of IC injections of BM-MSC on additional eight patients with DM-ED. RESULTS Each patient received 2 consecutive IC injections of BM-MSC and evaluated at 1, 3, 6, 12, and 24-month time points. Primary outcome was the tolerability and safety of stem cells therapy (SCT), while the secondary outcome was improvement of erectile function (EF) as assessed using the International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS) questionnaires, and Color Duplex Doppler Ultrasound (CDDU). IC injections of BM-MSCs was safe and well-tolerated. Minor local and short-term adverse events related to the bone marrow aspiration and IC injections were observed and treated conservatively. There were significant improvement in mean IIEF-5, EHS, all over the follow-up time points in comparison to the baseline. At 24-month follow up there were significant decline in the mean IIEF-5, and EHS compared to the baseline. The mean basal and 20-min peak systolic velocity was significantly higher at 3-month after the IC injections compared to baseline. CONCLUSIONS This phase 2 clinical trial confirmed that IC injections of BM-MSC are safe and improve EF. The decline in EF over time suggests a need for assessing repeated injections. CLINICAL TRIAL REGISTRATION NCT02945462.
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Affiliation(s)
- Saddam Al Demour
- Department of Special Surgery, Division of Urology, School of Medicine, The University of Jordan, Amman, 11942, Jordan.
- Dr. Sulaiman Al Habib Medical Group, Riyadh, Kingdom of Saudi Arabia.
| | - Sofia Adwan
- Cell Therapy Center, The University of Jordan, 11942, Amman, Jordan
- Department of Medical Laboratories, Faculty of Health Sciences, American University of Madaba, 11821, Madaba, Jordan
| | - Hanan Jafar
- Cell Therapy Center, The University of Jordan, 11942, Amman, Jordan
| | - Hussam Alhawari
- Department of Internal Medicine, School of Medicine, The University of Jordan, 11942, Amman, Jordan
| | - Abdalla Awidi
- Cell Therapy Center, The University of Jordan, 11942, Amman, Jordan.
- Department of Internal Medicine, School of Medicine, The University of Jordan, 11942, Amman, Jordan.
- Department of Hematology-Oncology, Jordan University Hospital, The University of Jordan, Amman, 11942, Jordan.
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Prieto LR, Shires DA, Xiong Y. Factors Associated with Erectile Dysfunction Among Older Gay Men. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02908-3. [PMID: 38839704 DOI: 10.1007/s10508-024-02908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 04/10/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
Erectile dysfunction (ED) is a common issue that aging men encounter, but whether internalized gay ageism (i.e., the internalization of ageist messages within the context of aging as a gay man) is related to ED among older gay men is unknown. A cross-sectional web-based survey explored the relationship between internalized gay ageism, health-related and social factors, and ED among older gay men who resided in the Midwest United States (N = 181). Internalized gay ageism was not significantly associated with ED. However, hierarchical regression analysis found that age (β = .224, t = 2.70, p = .008) and overall health (β = -.247, t = -3.05, p = .003) were significantly associated with ED among older gay men, suggesting that older gay men share similar risk factors for ED as the general male population. Future research should continue to explore other factors that are unique to gay men that may be associated with ED.
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Affiliation(s)
- Lucas R Prieto
- Department of Social Work, College of Public Health, George Mason University, Fairfax, VA, 22030, USA.
| | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, MI, USA
| | - Yuan Xiong
- School of Social Work, Michigan State University, East Lansing, MI, USA
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3
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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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Tozzi M, Jannello LMI, Silvaggi M, Michetti PM. Anxiety, depression, urinary continence, and sexuality in patients undergoing radical prostatectomy: preliminary findings. Support Care Cancer 2024; 32:294. [PMID: 38635029 DOI: 10.1007/s00520-024-08503-5] [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: 11/25/2023] [Accepted: 04/13/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Evaluate the relationship between psychological distress, namely anxiety and depression, with urinary continence and recovery of erectile function in patients undergoing radical prostatectomy (RP). METHODS We retrospectively analyzed data from 33 consecutive patients who underwent RP in a single tertiary-referral academy between 01/2018 to 01/2019. We used the International Index of Erectile Function (IIEF-15), the Sexual Complaints Screener for Men (SCS-M), and the Hospital Anxiety and Depression Scale (HADS), validated questionnaires for the assessment of sexual function, anxiety, and depression experiences, respectively. These questionnaires were administered at the pre-surgical visit, after surgery, and at intermediate follow-ups (three, six, and twelve months). RESULTS The analysis of the questionnaires completed during follow-up shows that erectile function is the most affected, with 90% erectile dysfunction (ED) at three months after surgery. In terms of emotional states, anxiety prevails in the first months following surgery and is statistically significantly associated with incontinence (p = 0.02). Depressive symptoms, on the other hand, appear later and prevail over anxiety at six months after surgery, although not statistically significant. CONCLUSIONS In the early post-surgical phase anxiety and ED are the most frequently detected components, while depressive experiences and decreased desire, typical of later stages, have not yet fully emerged.
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Affiliation(s)
- Marco Tozzi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Letizia Maria Ippolita Jannello
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
- Università Degli Studi Di Milano, Milan, Italy.
| | - Marco Silvaggi
- Institute of Clinical Sexology (ISC), Via Savoia 78, 00198, Rome, Italy
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Foster P, Luebke M, Razzak AN, Anderson DJ, Hasoon J, Viswanath O, Kaye AD, Urits I. Stigmatization as a Barrier to Urologic Care: A Review. Health Psychol Res 2023; 11:84273. [PMID: 37670795 PMCID: PMC10477007 DOI: 10.52965/001c.84273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Heavy societal stigma of certain conditions has created an environment where individuals may be hesitant to seek professional care. Urology is a specialized field that focuses on many of these conditions that society has deemed taboo to discuss. In this review, we address barriers that have prevented patients from seeking urologic care in order to better understand and elucidate important concerns within development of the physician-patient relationship. Recognizing these concerns can also assist in public health outreach approaches to motivate patients for seeking urologic care. The scope of this review was limited to three highly prevalent conditions affecting both men and women, including urinary incontinence, erectile dysfunction, and genitourinary syndrome of menopause.
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Affiliation(s)
| | | | | | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Alan D Kaye
- Department of Anesthesiology Louisiana State University Health
| | - Ivan Urits
- Department of Pain Medicine Southcoast Health
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Adus-salam A, Jimoh M, Ehiedu CG. Sexual characteristics of patients with prostate cancer seen for radiation treatment. Ecancermedicalscience 2023; 17:1577. [PMID: 37533949 PMCID: PMC10393305 DOI: 10.3332/ecancer.2023.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Indexed: 08/04/2023] Open
Abstract
Background Prostate cancer was estimated to be the second most diagnosed cancer and the fifth leading cause of cancer mortality among men, with an estimated 1.4 million new cases and 375,000 deaths globally in 2020. There are significant changes in sexual activities and subsequent changes in quality of life associated with the diagnosis and treatment of prostate cancer. Sexual problems experienced by prostate cancer patients include erectile dysfunction, reduced sexual desire, reduced sexual function, problems with ejaculation, as well as problems with orgasm, and these could occur before and/or after treatment. This study aims to highlight the sexual characteristics of prostate cancer patients, which would help identify altered sexuality that might require intervention by healthcare providers. Method All patients who presented with pathologically diagnosed, organ-confined prostate cancer referred for high-dose-rate brachytherapy were approached for participation in the study. An interviewer-administered questionnaire was administered to the consenting patients. Results A total of 56 patients gave consent for the study out of 60. All the patients were married, with 5 (8.9%) having multiple wives. Only ten respondents (17.9%) reported having other sexual partners besides their wives. More than half of the patients (34) (60.7%) started having sexual intercourse between the ages of 18 and 20. Many patients claimed that the diagnosis of prostate cancer had affected their sexual lives. About half of the respondents (44.6%) believed that their partners were less satisfied with their sexual performance, as evidenced by the loss of partners (5.4%), partners refusing sexual advances (14.3%), partners complaints (10.7%), and partners' reduced inclination to ask for sex (33.9%). One patient expressed fears of passing the disease to their partners. Conclusion The management of prostate cancer should include sex therapy and rehabilitation in couples from the point of diagnosis to maintain sexual function as close as possible to that in the general population in order to maintain an improved quality of life.
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Affiliation(s)
- Abbas Adus-salam
- Department of Radiation Oncology, University College Hospital/University of Ibadan, Ibadan 200212, Nigeria
- University College Hospital, Ibadan 200005, Nigeria
| | - Mutiu Jimoh
- Department of Radiation Oncology, University College Hospital/University of Ibadan, Ibadan 200212, Nigeria
- University College Hospital, Ibadan 200005, Nigeria
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Cózar-Ortiz JD, Cózar-Olmo JM, Álvarez-Ossorio-Fernández JL, Esteban-Fuertes M, Chantada-Abal V, Valverde-Martínez LS, Márquez-Sánchez MT, Padilla-Fernández BY, Lorenzo-Gómez MF. The impact of psychiatric pathology on the prognosis and survival of men with prostate cancer undergoing radical prostatectomy. Actas Urol Esp 2022; 46:646-652. [PMID: 36273759 DOI: 10.1016/j.acuroe.2022.10.003] [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: 02/22/2022] [Accepted: 03/06/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION AND OBJECTIVE Cancer-specific anxiety is the most frequently reported psychological response after radical prostatectomy (RP). We evaluated the prevalence of pretreatment psychiatric pathology in patients with prostate cancer undergoing RP and identified the effects of psychiatric diagnoses on their survival and prognosis. MATERIAL AND METHODS Retrospective multicenter observational study including 1078 men treated with RP for organ-confined prostate cancer. Groups: GP: patients with psychiatric pathology prior to RP; GNP: patients without psychiatric pathology prior to RP. Urological, oncological and psychiatric variables, descriptive statistics and multivariate analysis were included. RESULTS 37.94% of patients presented a psychiatric diagnosis. Adjuvant radiotherapy was required in 27.83% and hormone therapy in 23.38%; being more frequent in GP. Cancer-specific survival was higher in GNP. Anxiety, depression, insomnia, smoking, psychosis and alcoholism were the most frequent. Low TNM and low presence of LUTS and SUI increased the probability of absence of psychiatric pathology. Fatigue, erectile dysfunction and cognitive impairment after RP with RT and/or HT were higher in GP. Older age and higher PSA at diagnosis increased the relative risk of psychiatric pathology and worse outcome. The most frequently related factors were RP, PSA, age and survival time. CONCLUSIONS Psychiatric pathology is present in patients undergoing radical prostatectomy for prostate cancer, with a high impact on survival and prognostic outcomes.
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Affiliation(s)
- J D Cózar-Ortiz
- Servicio de Psiquiatría, Hospital Universitario Gómez Ulla, Madrid, Spain
| | - J M Cózar-Olmo
- Departamento de Cirugía, Universidad de Granada, Granada, Spain
| | | | - M Esteban-Fuertes
- Servicio de Urología, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - V Chantada-Abal
- Servicio de Urología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | | | | | - M F Lorenzo-Gómez
- Departamento de Cirugía, Universidad de Salamanca, Salamanca, Spain; Servicio de Urología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Impacto de la patología psiquiátrica en el pronóstico y supervivencia de los varones con cáncer de próstata tratados mediante prostatectomía radical. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Röscher P, Naidoo K, Milios JE, van Wyk JM. A modified Delphi study to identify screening items to assess neglected sexual side-effects following prostate cancer treatment. BMC Urol 2022; 22:34. [PMID: 35277157 PMCID: PMC8915514 DOI: 10.1186/s12894-022-00982-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neglected sexual side effects (NSSE) are a group of less common sexual side effects that may present after Prostate Cancer (PCa) treatment. There is currently no valid and reliable tool to identify these side effects. A modified Delphi study is an effective way of developing the content of such a screening tool. Methods A modified Delphi study was used to obtain consensus from a multi-disciplinary group of experts over 3 rounds during a 12 week period. Ten statements were presented containing 8 closed-ended statements on individual NSSEs, and 2 open-ended statements on psychosocial impact related to NSSE. Consensus was defined as a 75% strongly agree achievement on each statement, or the final statement evolution at the end of 3 rounds. Statement support in each round was determined by mean, standard deviation and range, after a numerical value was allocated to each statement during specific rounds. All three rounds were structured and suggestions and additions were incorporated in the statement evolution of the three rounds. Results Thirty-five participants were invited, and 27 completed Round 1 (RD 1), 23 participants completed RD2, and 20 participants completed RD3. All 3 rounds were completed in 12 weeks. Statement 1 (sexual arousal incontinence), statement 2 (climacturia) and statement 3 (orgasm intensity) reached consensus after RD2, and statement 9 (sexual dysfunction impact) and statement 10 (experiences) were removed after RD3. Statement 4 (orgasmic pain), statement 5 (anejaculation), statement 6 (sensory disturbances), statement 7 (penile length shortening) and statement 8 (penile curvature) were finalised after the conclusion of RD3. Statements 1–3 were the most stable statements with the most support and least amount of disagreement. Statements 4–8 were less stable, but support for them improved over the 3 rounds. Statements 9–10 both had good stability, but the support indicated that they needed to be removed from the set of statements. Statement 5 had the poorest range due to an outlier opinion. Conclusions Consensus was reached on the items making up the NSSE screening tool. Health care practitioners will be able to use this tool to identify the evidence of NSSE after PCa treatment. Further testing will be undertaken to confirm the reliability and validly of the tool. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-00982-0.
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Dinesh AA, Helena Pagani Soares Pinto S, Brunckhorst O, Dasgupta P, Ahmed K. Anxiety, depression and urological cancer outcomes: A systematic review. Urol Oncol 2021; 39:816-828. [PMID: 34503900 DOI: 10.1016/j.urolonc.2021.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/25/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The interplay between physical and mental aspects of a cancer diagnosis are well recognised. However, little consensus exists on the impact of depression and anxiety on urological cancer outcomes. Therefore, this systematic review aimed to investigate the relationship between these conditions and functional or oncological outcomes in urological malignancy. MATERIALS AND METHODS A systematic search was conducted using PubMed, Embase, PsycINFO and Global Health databases up to June 2020. Studies evaluating the relationship of anxiety and depression disorders or symptoms on functional and mortality outcomes were included. Outcome measures included validated urinary, sexual, body image questionnaire scores and all-cause or disease-specific mortality. RESULTS Of 3,966 studies screened, 25 studies with a total of 175,047 urological cancer patients were included. Significant anxiety and depressive symptoms and disorders were found to impact functional outcomes in several cancer types. A consistent negative association existed for sexual function in prostate, testicular and penile cancer patients. Additionally, poorer urinary function scores were seen in prostate cancer, with increased body image issues in testicular and prostate cancer. Importantly, both overall and disease-specific mortality outcomes were poorer in bladder and prostate cancer patients. CONCLUSIONS Co-existing depression and anxiety appears to be negatively associated with functional and mortality outcomes in urological cancers. This appears especially evident in male cancers, including prostate and testicular cancer. Although not proving causation, these findings highlight the importance of considering mental wellbeing during follow-up for early recognition and treatment. However, current evidence remains heterogenous, with further studies required exploring patients at risk.
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Affiliation(s)
- Ayushi Anna Dinesh
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | | | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom; Department of Urology, King's College Hospital, London, United Kingdom.
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Prevalence of erectile dysfunction in male survivors of cancer: a systematic review and meta-analysis of cross-sectional studies. Br J Gen Pract 2021; 71:e372-e380. [PMID: 33926885 PMCID: PMC8087306 DOI: 10.3399/bjgp20x714197] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/17/2020] [Indexed: 01/26/2023] Open
Abstract
Background Prevalence of erectile dysfunction (ED) in male survivors of cancer across cancer types has not been systematically analysed. Aim To estimate the prevalence of ED in all types of cancer and identify characteristics associated with ED in survivors of cancer. Design and setting Systematic review and meta-analysis (MA) of cross-sectional studies. Method MEDLINE, CINAHL, PsycINFO, and EMBASE were searched, targeting reports published from inception to 1 February 2020. All retrospective or prospective studies reporting prevalence of ED in male patients with cancer and using a validated tool for detection of ED were included. A random-effects MA model was used to pool prevalence of ED as absolute estimates at three different stages, that is, ‘healthy’, ‘at diagnosis’, and ‘after treatment’. A univariate MA regression including the three-level group variable as the only independent variable was used to assess the difference in ED prevalence across the three groups. Further MAs were conducted for studies involving patients at diagnosis and after treatment, and statistical inferences were made with setting for multiple testing controlling for a false discovery rate (FDR) <0.05. Results In total, 1301 studies were assessed for inclusion. Of these, 141 were potentially eligible and subsequently scrutinised in full text. Finally, 43 studies were included with a total of 13 148 participants. Overall, pooled data of the included studies showed an ED prevalence of 40.72% (95% confidence interval [CI] = 31.80 to 50.29) in patients with cancer, with prevalences of 28.60% (95% CI = 12.10 to 53.83) at time of diagnosis and 42.70% (95% CI = 32.97 to 53.03) after treatment, with significant difference between these two stages and across cancer locations, controlling for an FDR <0.05. Conclusion Erectile dysfunction was particularly high in male survivors of cancer and was associated with cancer treatment, cancer site, and age.
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Sexual function and rehabilitation after radiation therapy for prostate cancer: a review. Int J Impot Res 2021; 33:410-417. [PMID: 33408347 DOI: 10.1038/s41443-020-00389-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/10/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
The treatment of prostate cancer is partly guided by patient preferences. Radical prostatectomy and radiation therapy are the standard radical therapies for localized disease and render comparable oncologic outcomes. Considering that survival is high regardless of the chosen treatment, factors such as treatment-related toxicities affecting the patients' quality of life play an important role in their decision. Notably, post-treatment sexual dysfunction, which includes decreased libido, erectile dysfunction, and ejaculatory dysfunction has been shown to be an important and prevalent concern of prostate cancer survivors. In this literature review, we sought to characterize the sexual complications associated with radiation therapy and map the available sexual rehabilitation options for prostate cancer survivors experiencing sexual dysfunction as a result of radiation therapy. We identified medical, non-biomedical, counseling, and lifestyle modification options for prostate cancer survivors seeking sexual rehabilitation. Future research in this area should address the standardization of sexual side-effect reporting and investigate sexual outcomes and rehabilitation in more diverse groups and of transgender and nonheterosexual prostate cancer survivors.
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Whalen S, Langille G, White J, Bailly G. Access to penile prostheses differ across provinces in Canada: A survey of Canadian urologists. Can Urol Assoc J 2020; 15:E346-E349. [PMID: 33382371 DOI: 10.5489/cuaj.6867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Surgical implantation of a penile prosthesis is the gold standard treatment for refractory erectile dysfunction. The purpose of this study was to investigate the use of and access to these procedures in Canada. METHODS Canadian urologists known to perform penile prostheses procedures were surveyed on areas such as surgical volume, type of device used, and the direct cost to patients for both malleable and inflatable devices. RESULTS Of the 50 urologists invited to participate in the study, 34 (68%) completed the online survey. Participants represented nine Canadian provinces and included a mix of academic (65%) and community (35%) urologists. Most participants (79%) performed less than 10 procedures per year. Roughly three-quarters of participants (74%) used inflatable devices in over 90% of cases, while half implanted inflatable devices exclusively. The most common devices implanted were American Medical Systems (AMS). Participants from Alberta, Manitoba, New Brunswick, and Newfoundland reported full coverage for both malleable and inflatable devices. Saskatchewan was the only province where no coverage was reported. The remaining provinces were found to have variable degrees of coverage. Across all centers without full coverage, the median reported cost to patients for a malleable and inflatable device was $5000 and $6000, respectively. CONCLUSIONS The urologists surveyed most commonly perform inflatable penile prostheses procedures. Significant geographical differences exist with respect to reported coverage for these procedures. This study highlights the need for continued advocacy on behalf of the urological community towards the goal of equity in coverage for penile prostheses across Canada.
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Affiliation(s)
- Stewart Whalen
- Department of Urology, Dalhousie University, Halifax, NS Canada
| | - Gavin Langille
- Department of Urology, Dalhousie University, Saint John, NB, Canada
| | - Josh White
- Department of Urology, Dalhousie University, Halifax, NS Canada
| | - Greg Bailly
- Department of Urology, Dalhousie University, Halifax, NS Canada
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Naccarato AMEP, Consuelo Souto S, Matheus WE, Ferreira U, Denardi F. Quality of life and sexual health in men with prostate cancer undergoing radical prostatectomy. Aging Male 2020; 23:346-353. [PMID: 30040004 DOI: 10.1080/13685538.2018.1486397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The aim of this study was to evaluate the relationship between quality of life, erectile function and group psychotherapy in patients with prostate cancer undergoing radical prostatectomy. Sixty patients were evaluated for erectile function (IIEF-5), quality of life (SF-36SF), urinary incontinence (ICQI-SF and ICQI-OAB). Thirty of them had group psychotherapy two weeks before and 12 weeks after surgery. Patients who underwent group psychotherapy had better scores in IIEF-5, satisfaction with life in general, satisfaction with sexual life and in partner relationship; better results of SF-36SF, excepting two domains: bodily pain and role emotional. There were significant correlations between IIEF-5 and perception of discomfort (p = .030), physical functioning (p = .021), physical component (p = .005) and role emotional (p = .009) in patients undergoing group psychotherapy. In patients who didn't have group psychotherapy there were significant correlations between ICQI-OAB and perception of discomfort (p = .025), social functioning (p = .052) and role emotional (p = .034); between ICQI-SF and perception of discomfort (p = .0001). Group psychotherapy has a positive impact in quality of life and erectile function. There was no difference in the urinary function of the two groups. Further studies are necessary to identify the impact of self-perception and self-knowledge in the postoperative management of radical prostatectomy.
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Affiliation(s)
- Angela M E P Naccarato
- Department of Urologic Oncology, State University of Campinas - Unicamp, Campinas, Brazil
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15
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Madan R, Dracham CB, Khosla D, Goyal S, Yadav AK. Erectile dysfunction and cancer: current perspective. Radiat Oncol J 2020; 38:217-225. [PMID: 33233032 PMCID: PMC7785841 DOI: 10.3857/roj.2020.00332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/19/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022] Open
Abstract
Erectile dysfunction (ED) is one of the major but underreported concerns in cancer patients and survivors. It can lead to depression, lack of intimacy between the couple, and impaired quality of life. The causes of erectile dysfunction are psychological distress and endocrinal dysfunction caused by cancer itself or side effect of anticancer treatment like surgery, radiotherapy, chemotherapy and hormonal therapy. The degree of ED depends on age, pre-cancer or pre-treatment potency level, comorbidities, type of cancer and its treatment. Treatment options available for ED are various pharmacotherapies, mechanical devices, penile implants, or reconstructive surgeries. A complete evaluation of sexual functioning should be done prior to starting anticancer therapy. Management should be individualized and couple counseling should be an integral part of the anticancer treatment.
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Affiliation(s)
- Renu Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Chinna Babu Dracham
- Department of Radiation Oncology, Queen’s NRI Hospital, Visakhapatnam, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shikha Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Kumar Yadav
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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16
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Seguin L, Touzani R, Bouhnik AD, Charif AB, Marino P, Bendiane MK, Gonçalves A, Gravis G, Mancini J. Deterioration of Sexual Health in Cancer Survivors Five Years after Diagnosis: Data from the French National Prospective VICAN Survey. Cancers (Basel) 2020; 12:cancers12113453. [PMID: 33233583 PMCID: PMC7699784 DOI: 10.3390/cancers12113453] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
Little is known about cancer survivors' sexual health (SH)-particularly, from well after diagnosis and in cancers unrelated to sexuality. This study aimed to assess SH deterioration five years after diagnosis. We analyzed data from the French national VIe après le CANcer (VICAN) survey. Six items from the Relationship and Sexuality Scale were used to assess SH. Respondents were grouped according to an ascending hierarchical classification in four clusters: strong, moderate, and weak deterioration or stable (WD, SD, MD, or St). Out of 2195 eligible participants, 57.3% reported substantial SH deterioration as either SD (30.8%) or MD (26.5%), while WD and St accounted for 31.2% and 11.5% of respondents, respectively. Substantial deterioration was reported in all cancer sites (from 27.7% in melanoma to 83.1% in prostate). Treatment type, cancer sequelae, and pain, as well as psychological consequences (depression and anxiety, especially for younger patients) were associated with substantial SH deterioration. The same factors were identified after restricting the analysis to survivors of cancers unrelated to sexuality. Five years after diagnosis, the majority of cancer survivors reported SH deterioration. Interventions should be developed to improve SH regardless of cancer site. Particular attention should be paid to depression and anxiety, especially in younger survivors.
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Affiliation(s)
- Lorène Seguin
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, 13009 Marseille, France; (A.G.); (G.G.)
| | - Rajae Touzani
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Institut Paoli-Calmettes, SESSTIM U1252, 13009 Marseille, France
| | - Anne-Déborah Bouhnik
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Correspondence: ; Tel.: +33-(0)491-223-502
| | - Ali Ben Charif
- VITAM—Centre de recherche en santé durable Quebec, Quebec, QC G1J0A4, Canada;
| | - Patricia Marino
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
- Institut Paoli-Calmettes, SESSTIM U1252, 13009 Marseille, France
| | - Marc-Karim Bendiane
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille Univ, 13009 Marseille, France; (L.S.); (R.T.); (P.M.); (M.-K.B.)
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, 13009 Marseille, France; (A.G.); (G.G.)
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, 13009 Marseille, France; (A.G.); (G.G.)
| | - Julien Mancini
- APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Hop Timone, BioSTIC, Biostatistique et Technologies de l’Information et de la Communication, Aix Marseille Univ, 13005 Marseille, France;
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17
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Fervaha G, Izard JP, Tripp DA, Aghel N, Shayegan B, Klotz L, Niazi T, Fradet V, Taussky D, Lavallée LT, Hamilton RJ, Brown I, Chin J, Gopaul D, Violette PD, Davis MK, Karampatos S, Pinthus JH, Leong DP, Siemens DR. Psychological morbidity associated with prostate cancer: Rates and predictors of depression in the RADICAL PC study. Can Urol Assoc J 2020; 15:181-186. [PMID: 33212008 DOI: 10.5489/cuaj.6912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Across all cancer sites and stages, prostate cancer has one of the greatest median five-year survival rates, highlighting the important focus on survivorship issues following diagnosis and treatment. In the current study, we sought to evaluate the prevalence and predictors of depression in a large, multicenter, contemporary, prospectively collected sample of men with prostate cancer. METHODS Data from the current study were drawn from the baseline visit of men enrolled in the RADICAL PC study. Men with a new diagnosis of prostate cancer or patients initiating androgen deprivation therapy for prostate cancer for the first time were recruited. Depressive symptoms were evaluated using the nine-item version of the Patient Health Questionnaire (PHQ-9). To evaluate factors associated with depression, a multivariable logistic regression model was constructed, including biological, psychological, and social predictor variables. RESULTS Data from 2445 patients were analyzed. Of these, 201 (8.2%) endorsed clinically significant depression. Younger age (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.16-1.60 per 10-year decrease), being a current smoker (OR 2.77, 95% CI 1.66-4.58), former alcohol use (OR 2.63, 95% CI 1.33-5.20), poorer performance status (OR 5.01, 95% CI 3.49-7.20), having a pre-existing clinical diagnosis of depression or anxiety (OR 3.64, 95% CI 2.42-5.48), and having high-risk prostate cancer (OR 1.49, 95% CI 1.05-2.12) all conferred independent risk for depression. CONCLUSIONS Clinically significant depression is common in men with prostate cancer. Depression risk is associated with a host of biopsychosocial variables. Clinicians should be vigilant to screen for depression in those patients with poor social determinants of health, concomitant disability, and advanced disease.
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Affiliation(s)
- Gagan Fervaha
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jason P Izard
- Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Oncology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Dean A Tripp
- Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Psychology, Faculty of Arts and Sciences, Queen's University, Kingston, ON, Canada.,Department of Anesthesia, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Nazanin Aghel
- Division of Cardiology, Cardio-Oncology Program, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Laurence Klotz
- Sunnybrook Health Sciences Centre, and Department of Surgery (Urology), University of Toronto, Toronto, ON, Canada
| | - Tamim Niazi
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Vincent Fradet
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada, and Centre de recherche du CHU de Québec-Université Laval, axe Oncologie, Quebec City, QC, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal-CHUM, Montreal, QC, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert J Hamilton
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, and Department of Surgery (Urology), University of Toronto, Toronto, ON, Canada
| | | | | | - Darin Gopaul
- Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | - Philippe D Violette
- Department of Surgery and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Margot K Davis
- Department of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Karampatos
- The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jehonathan H Pinthus
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Darryl P Leong
- The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - D Robert Siemens
- Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Department of Oncology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
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18
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Britt D, Blankstein U, Lenardis M, Millman A, Grober E, Krakowsky Y. Availability of platelet-rich plasma for treatment of erectile dysfunction and associated costs and efficacy: A review of current publications and Canadian data. Can Urol Assoc J 2020; 15:202-206. [PMID: 33212009 DOI: 10.5489/cuaj.6947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Platelet-rich plasma (PRP) is an increasingly used unconventional treatment option for erectile dysfunction (ED). The validity of PRP as a potential treatment for ED has been proposed in limited human trials. Furthermore, the costs associated with PRP for ED treatment are not readily promoted to patients. The goal of this review was to determine the efficacy and costs of PRP based on currently available literature and Canadian data. METHODS A comprehensive literature review of available PRP studies and current published data pertaining to cost, availability, and provider clinics globally was conducted using the PubMed database. Physicians offering genital PRP in Canada were identified using internet searches and PRP provider directories. Physician qualifications, clinic locations, and cost information were obtained from provider websites and telephone calls to identified clinics. RESULTS Availability of PRP injections offered for treating ED is increasing globally. There are currently no peer-reviewed publications to substantiate anecdotal evidence pertaining to the efficacy of PRP as a viable treatment option for ED patients. Our results indicate 19 providers for PRP injections in Canada, costing on average $1777 CAD per injection. No providers were affiliated with academic institutions and providers varied in their area of clinical speciality and training. CONCLUSIONS To our knowledge, there is currently no research underway investigating the clinical efficacy of PRP for ED treatment despite its broad availability and significant cost. Patients should be informed of the lack of substantiated efficacy and safety data, as the reliability of PRP treatments requires further evaluation.
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Affiliation(s)
- Deron Britt
- University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada
| | - Udi Blankstein
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | | | - Ethan Grober
- Women's College Hospital, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Yonah Krakowsky
- Women's College Hospital, Division of Urology, University of Toronto, Toronto, ON, Canada
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19
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Duthie CJ, Calich HJ, Rapsey CM, Wibowo E. Maintenance of sexual activity following androgen deprivation in males. Crit Rev Oncol Hematol 2020; 153:103064. [DOI: 10.1016/j.critrevonc.2020.103064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 05/12/2020] [Accepted: 07/12/2020] [Indexed: 01/14/2023] Open
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Milios JE, Ackland TR, Green DJ. Pelvic Floor Muscle Training and Erectile Dysfunction in Radical Prostatectomy: A Randomized Controlled Trial Investigating a Non-Invasive Addition to Penile Rehabilitation. Sex Med 2020; 8:414-421. [PMID: 32418881 PMCID: PMC7471070 DOI: 10.1016/j.esxm.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/15/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Pelvic floor muscle (PFM) training for postprostatectomy incontinence is considered a first line approach to rehabilitation, but PFM training for erectile dysfunction (ED) after surgery is less well known. With more than 1.4 million new cases diagnosed globally per year, there is a need for non-invasive options to assist sexual dysfunction recovery. AIM Commencing preoperatively and using both fast and slow twitch fibre training performed in standing postures, new protocols were developed to address clinical presentations with aims to reduce ED and impact on quality of life (QoL). Comparisons with "usual care" PFM training, prerehabilitation and postrehabilitation were then assessed. METHODS A randomised controlled trial of 97 men undergoing radical prostatectomy (RP) were allocated to either a control group (n = 47) performing "usual care" of 3 sets/d PFMT or an intervention group (n = 50), performing 6 sets/d in standing, commencing 5 weeks before RP. OUTCOME MEASURES Participants were assessed preoperatively and at 2, 6, and 12 weeks after RP using the Expanded Prostate Cancer Index Composite for Clinical Practice, International Index of Erectile Function-5, and real time ultrasound measurements of PFM function. RESULTS At all time points, there was a significant difference (P< 0.05) between groups; however, the only time point where this difference was clinically relevant was at 2 weeks after RP, with the intervention group reporting less distress in the Expanded Prostate Cancer Index Composite for Clinical Practice QoL outcome. Secondary measures of EPIC-EF and real time ultrasound PFM function tests demonstrated improvement over all time points in both groups with lower bothersome scores in the intervention group. CONCLUSIONS Early PFM training reduces early QoL impact for postprostatectomy ED, with faster return to continence enabling earlier commencement of penile rehabilitation. While our 12-week protocol and sample size was not powerful enough to demonstrate conclusive benefits of early PFM training for ED, PFM intervention after RP over longer times has been supported by others. Milios JE, Ackland TR, Green DJ. Pelvic Floor Muscle Training and Erectile Dysfunction in Radical Prostatectomy: A Randomized Controlled Trial Investigating a Non-Invasive Addition to Penile Rehabilitation. J Sex Med 2020;8:414-421.
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Affiliation(s)
- Joanne E Milios
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Western Australia.
| | - Timothy R Ackland
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Western Australia
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Western Australia
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Kumagai H, Yoshikawa T, Myoenzono K, Kosaki K, Akazawa N, Tanahashi K, Tagawa K, Zempo-Miyaki A, Maeda S. Role of High Physical Fitness in Deterioration of Male Sexual Function in Japanese Adult Men. Am J Mens Health 2020; 13:1557988319849171. [PMID: 31068078 PMCID: PMC6509982 DOI: 10.1177/1557988319849171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Male sexual function is regulated by vascular function and impaired vascular function is closely related with erectile dysfunction (ED). Vascular functions are positively influenced by physical fitness (i.e., aerobic capacity, muscle strength, and flexibility). The detailed associations between physical fitness and male sexual function remain poorly understood. The present study aimed to clarify the influence of physical fitness on male sexual function. In 177 adult men, peak oxygen consumption (VO2 peak), handgrip strength (HGS), and sit and reach were measured as indices of physical fitness. Arterial stiffness and erectile function were assessed by carotid-femoral pulse wave velocity (cfPWV) and the International Index of Erectile Function 5 (IIEF5) questionnaire, respectively. IIEF5 score was significantly correlated with VO2 peak ( rs = 0.52), HGS ( rs = 0.37), and cfPWV ( rs = -0.44); and multivariate linear regression analyses showed that VO2 peak, HGS, and cfPWV were significantly associated with IIEF5 score after considering confounders. The receiver operator characteristic curve analysis suggested that the cutoff values for predicting ED were 29.0 ml/min/kg for VO2 peak and 39.3 kg for HGS. The IIEF5 score was the highest in the subjects with the values of both VO2 peak and HGS were higher than their respective cutoff values, while the IIEF5 score was the lowest in the subjects with the values of both VO2 peak and HGS were lower than their respective cutoff values. These results suggest that the maintenance of high aerobic capacity and muscular strength may offset deterioration of male sexual function.
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Affiliation(s)
- Hiroshi Kumagai
- 1 Faculty of Health and Sport Sciences, University of Tsukuba, Japan.,2 Graduate School of Health and Sports Science, Juntendo University, Japan.,3 Japan Society for the Promotion of Science, Chiyoda-ku, Japan
| | - Toru Yoshikawa
- 4 Faculty of Sports and Health Science, Ryutsu Keizai University, Japan
| | - Kanae Myoenzono
- 5 Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Keisei Kosaki
- 1 Faculty of Health and Sport Sciences, University of Tsukuba, Japan.,3 Japan Society for the Promotion of Science, Chiyoda-ku, Japan
| | - Nobuhiko Akazawa
- 1 Faculty of Health and Sport Sciences, University of Tsukuba, Japan.,6 Japan Institute of Sport Sciences, Japan
| | | | - Kaname Tagawa
- 5 Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | | | - Seiji Maeda
- 1 Faculty of Health and Sport Sciences, University of Tsukuba, Japan
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Effects of resistance exercise in prostate cancer patients : A systematic review update as of March 2020. Wien Klin Wochenschr 2020; 132:452-463. [PMID: 32681360 PMCID: PMC7445198 DOI: 10.1007/s00508-020-01713-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/27/2020] [Indexed: 02/08/2023]
Abstract
Purpose The aim of this systematic review is to provide an update on the effects of resistance exercise (RE) in patients with prostate cancer (PCa), with special attention to the effects on sexual health. Methods A systematic search of the literature was conducted in March 2020 using the databases PubMed, MEDLINE, EMBASE, SCOPUS and the Cochrane Library. Only randomized, controlled trials published after 31 December 2016 were included in this update. Additionally, articles from current and previous reviews were utilized to provide a brief summary of the effects on sexual health. Results A total of 10 articles met the inclusion criteria, of which 5 were identified as independent studies. The remaining five articles presented additional data for studies, which have already been included. The identified studies further strengthened the evidence for positive effects on muscle strength, body composition and physical function. Positive effects on bone mineral density were apparent only when RE was combined with impact training. One article reported an improvement in fatigue and health-related quality of life. Only one study examined the effects of RE in isolation and three articles indicated positive effects of exercise on sexual health. Conclusion Recent evidence supports the use of RE in PCa patient rehabilitation as a countermeasure for treatment side effects. Further research is necessary to ascertain the optimal delivery methods and illuminate the effects on health-related quality of life (HRQOL), fatigue and sexual health.
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Risk of erectile dysfunction after modern radiotherapy for intact prostate cancer. Prostate Cancer Prostatic Dis 2020; 24:128-134. [PMID: 32647352 DOI: 10.1038/s41391-020-0247-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/05/2020] [Accepted: 06/30/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is a prevalent side effect of prostate cancer treatment. We hypothesized that the previously reported rates of ED may have improved with the advent of modern technology. The purpose of this project was to evaluate modern external beam radiotherapy and brachytherapy techniques to determine the incidence of radiotherapy (RT) induced ED. METHODS A systematic review of the literature published between January 2002 and December 2018 was performed to obtain patient reported rates of ED after definitive external beam radiotherapy, ultrafractionated stereotactic radiotherapy, and brachytherapy (BT) to the prostate in men who were potent prior to RT. Univariate and multivariate analyses of radiation dose, treatment strategy, and length of follow-up were analyzed to ascertain their relationship with RT-induced ED. RESULTS Of 890 articles reviewed, 24 met inclusion criteria, providing data from 2714 patients. Diminished erectile function status post RT was common and similar across all studies. The median increase in men reporting ED was 17%, 26%, 23%, and 23%, 3DCRT, IMRT, low dose rate BT, and SBRT, respectively, at 2-year median follow-up. CONCLUSION ED is a common side effect of RT. Risk of post-RT ED is similar for both LDR brachytherapy and external beam RT with advanced prostate targeting and penile-bulb sparing techniques utilized in modern RT techniques.
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24
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Adikari A, de Silva D, Ranasinghe WKB, Bandaragoda T, Alahakoon O, Persad R, Lawrentschuk N, Alahakoon D, Bolton D. Can online support groups address psychological morbidity of cancer patients? An artificial intelligence based investigation of prostate cancer trajectories. PLoS One 2020; 15:e0229361. [PMID: 32130256 PMCID: PMC7055800 DOI: 10.1371/journal.pone.0229361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/04/2020] [Indexed: 11/29/2022] Open
Abstract
Background Online Cancer Support Groups (OCSG) are becoming an increasingly vital source of information, experiences and empowerment for patients with cancer. Despite significant contributions to physical, psychological and emotional wellbeing of patients, OCSG are yet to be formally recognised and used in multidisciplinary cancer support programs. This study highlights the opportunity of using Artificial Intelligence (AI) in OCSG to address psychological morbidity, with supporting empirical evidence from prostate cancer (PCa) patients. Methods A validated framework of AI techniques and Natural Language Processing (NLP) methods, was used to investigate PCa patient activities based on conversations in ten international OCSG (18,496 patients- 277,805 conversations). The specific focus was on activities that indicate psychological morbidity; the reasons for joining OCSG, deep emotions and the variation from joining through to milestones in the cancer trajectory. Comparative analyses were conducted using t-tests, One-way ANOVA and Tukey-Kramer post-hoc analysis. Findings PCa patients joined OCSG at four key phases of psychological distress; diagnosis, treatment, side-effects, and recurrence, the majority group was ‘treatment’ (61.72%). The four groups varied in expression of the intense emotional burden of cancer. The ‘side-effects’ group expressed increased negative emotions during the first month compared to other groups (p<0.01). A comparison of pre-treatment vs post-treatment emotions showed that joining pre-treatment had significantly lower negative emotions after 12-months compared to post-treatment (p<0.05). Long-term deep emotion analysis reveals that all groups except ‘recurrence’ improved in emotional wellbeing. Conclusion This is the first empirical study of psychological morbidity and deep emotions expressed by men with a new diagnosis of cancer, using AI. PCa patients joining pre-treatment had improved emotions, and long-term participation in OCSG led to an increase in emotional wellbeing, indicating a decrease in psychological distress. It is opportune to further investigate AI in OCSG for early psychological intervention as an adjunct to conventional intervention programs.
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Affiliation(s)
- Achini Adikari
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, Victoria, Australia
| | - Daswin de Silva
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, Victoria, Australia
| | - Weranja K. B. Ranasinghe
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, Victoria, Australia
- MD Anderson Cancer Center, University of Texas, Houston, Texas
- * E-mail:
| | - Tharindu Bandaragoda
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, Victoria, Australia
| | - Oshadi Alahakoon
- College of Engineering and Science, Victoria University, Heidelberg, Victoria, Australia
| | - Raj Persad
- NHS Trust, North Bristol, England, United Kingdom
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne and Olivia Newton-John Cancer Centre, Austin Hospital, Melbourne, Australia
- EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare, Melbourne, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Damminda Alahakoon
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, Victoria, Australia
| | - Damien Bolton
- Department of Surgery, University of Melbourne and Olivia Newton-John Cancer Centre, Austin Hospital, Melbourne, Australia
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Krughoff K, Munarriz RM, Gross MS. An assessment of current penile prosthesis reimbursement guidelines for insurance plans nationwide. Int J Impot Res 2020; 33:55-58. [PMID: 31896830 DOI: 10.1038/s41443-019-0226-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 11/09/2022]
Abstract
A lack of uniformity exists for insurance payer coverage for all categories of penile prostheses (PP). We sought to determine common insurance coverage criteria and barriers to implantation across common insurance plans from healthcare referral regions (HRR) nationwide. Coverage criteria and stipulations were reviewed regarding erectile dysfunction (ED) etiology, ED duration, contributing comorbid conditions, medications, drug use, diagnostic tests, use of procedures and prior interventions. Seventy of 100 plans included coverage criteria. 36.1% provided coverage only in cases of gender dysphoria. 27.7% required documentation of trial, contraindication or intolerance to pharmacologic therapy, with varying descriptors of what this entailed. 13.8% required at least consideration of prior pharmacologic therapy. 4.2% required trial or contraindication to classic second-line therapies. 25.0% stated that ED must be organic. Psychogenic ED was covered by 12.5% of plans. Eleven plans required at least 6 or 12 months of symptoms. Laboratory evaluation to rule out hypogonadism or hyperprolactinemia was required by five plans. Insurance coverage criteria for PP placement were highly variable by state and plan. Coverage is provided for PP implantation in most cases for ED of organic etiology following failure of pharmacologic therapy when contributing comorbidities are optimally managed.
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26
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Dyer A, Kirby M, White ID, Cooper AM. Management of erectile dysfunction after prostate cancer treatment: cross-sectional surveys of the perceptions and experiences of patients and healthcare professionals in the UK. BMJ Open 2019; 9:e030856. [PMID: 31585974 PMCID: PMC6797309 DOI: 10.1136/bmjopen-2019-030856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Erectile dysfunction (ED) is known to be a common consequence of radical treatment for prostate cancer (PCa) but is often under-reported and undertreated. This study aimed to explore how ED in patients with PCa is managed in real-life clinical practice, from the perspective of patients and healthcare professionals (HCPs). DESIGN AND SETTING This is a UK-wide cross-sectional survey of men with ED after treatment for PCa which covered assessment and discussion of erectile function, provision of supportive care and satisfaction with management. Parallel surveys of primary and secondary HCPs were also conducted. RESULTS Responses were received from 546 men with ED after PCa treatment, 167 primary (general practitioners and practice nurses) and 94 secondary care HCPs (urologists and urology clinical nurse specialists). Survey findings revealed inadequate management of ED in primary care, particularly underprescribing of effective management options. A fifth of men (21%) were not offered any ED management, and a similar proportion (23%) were not satisfied with the way HCPs addressed their ED concerns. There was poor communication between HCPs and men, including failure to initiate discussions about ED and/or involve partners, with 12% of men not told that ED was a risk factor of PCa treatment. These issues seemed to reflect poor access to effective ED management or services and lack of primary HCP confidence in managing ED, as well as confusion over the roles and responsibilities among both HCPs and men. CONCLUSIONS This study confirms the need for better support for men from HCPs and more tailored and timely access to effective ED management after treatment for PCa. A clearly defined pathway is required for the discussion and management of ED, starting from the planning stage of PCa treatment. Improved adherence to ED management guidelines and better education and training for primary care HCPs are areas of priority.
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Affiliation(s)
- Amy Dyer
- Knowledge Team, Prostate Cancer UK, London, UK
| | - Mike Kirby
- The Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
- The Prostate Centre, London, UK
| | - Isabel D White
- Department of Pastoral and Psychological Care, Royal Marsden NHS Foundation Trust, London, UK
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Erim DO, Bensen JT, Mohler JL, Fontham ETH, Song L, Farnan L, Delacroix SE, Peters ES, Erim TN, Chen RC, Gaynes BN. Prevalence and predictors of probable depression in prostate cancer survivors. Cancer 2019; 125:3418-3427. [PMID: 31246284 DOI: 10.1002/cncr.32338] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The early diagnosis and treatment of depression are cancer care priorities. These priorities are critical for prostate cancer survivors because men rarely seek mental health care. However, little is known about the epidemiology of depression in this patient population. The goal of this study was to describe the prevalence and predictors of probable depression in prostate cancer survivors. METHODS The data were from a population-based cohort of North Carolinian prostate cancer survivors who were enrolled from 2004 to 2007 in the North Carolina-Louisiana Prostate Cancer Project (n = 1031) and were prospectively followed annually from 2008 to 2011 in the Health Care Access and Prostate Cancer Treatment in North Carolina study (n = 805). Generalized estimating equations were used to evaluate an indicator of probable depression (Short Form 12 mental composite score ≤48.9; measured at enrollment and during the annual follow-up) as a function of individual-level characteristics within the longitudinal data set. RESULTS The prevalence of probable depression fell from 38% in the year of the cancer diagnosis to 20% 6 to 7 years later. Risk factors for probable depression throughout the study were African American race, unemployment, low annual income, younger age, recency of cancer diagnosis, past depression, comorbidities, treatment decisional regret, and nonadherence to exercise recommendations. CONCLUSIONS Depression is a major challenge for prostate cancer survivors, particularly in the first 5 years after the cancer diagnosis. To the authors' knowledge, this is the first study to demonstrate an association between treatment decisional regret and probable depression.
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Affiliation(s)
- Daniel O Erim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,RTI International, Research Triangle Park, North Carolina
| | - Jeannette T Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Elizabeth T H Fontham
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Lixin Song
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Scott E Delacroix
- Department of Urology, Louisiana State University, New Orleans, Louisiana
| | - Edward S Peters
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | | | - Ronald C Chen
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
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28
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Chung KJ, Shim SR, Brown S, Shim YS, Park IB, Kim KH. Does early depressive mood expire following radical retropubic prostatectomy in patients with localized prostate cancer? J Exerc Rehabil 2019; 15:264-269. [PMID: 31111011 PMCID: PMC6509445 DOI: 10.12965/jer.1938160.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/28/2019] [Indexed: 11/22/2022] Open
Abstract
In this study, the pattern of depressive mood in patients following radical prostatectomy (RP) for localized prostate cancer (PCa) was determined. A total of 30 patients (aged 68.03±6.1 years) who were diagnosed with localized PCa and underwent RP within 1 month entered the study. Evaluations included body mass index, prostate-specific antigen, testosterone, underlying disease, international prostate symptom score and quality of life (QoL), international index of erectile function as well as Beck depression inventory (BDI), both at the initial stage and 3 months later. Basic demographic data, laboratory results, and questionnaires were analyzed statistically. The BDI score significantly decreased 3 months after the surgery. In correlation analysis, BDI was related with the international prostate symptom score but not with the underlying disease, QoL or international index of erectile function. Body mass index was identified as one of the risk factors to decrease the probability of BDI score (≥3) significantly. Underlying disease increased the probability of BDI score. In the assessment of the correlation between BDI and each subscale, sadness, self-dislike, self-criticalness, and worth-lessness showed high correlation. In the early period, depressive mood was improved at the short-term follow-up in localized PCa patients after RP. Voiding symptoms were only related with the depressive mood, but not with other parameters, including sexual function. The depressive mood had no effect on the QoL in the early stage.
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Affiliation(s)
- Kyung Jin Chung
- Department of Urology, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Sung-Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Suzana Brown
- Department of Technology and Society, The State University of New York (SUNY) in Korea, Incheon, Korea
| | - Young Sup Shim
- Department of Radiology, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Ie Byung Park
- Department of Endocrinology and Metabolism, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Khae-Hawn Kim
- Department of Urology, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
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Twitchell DK, Wittmann DA, Hotaling JM, Pastuszak AW. Psychological Impacts of Male Sexual Dysfunction in Pelvic Cancer Survivorship. Sex Med Rev 2019; 7:614-626. [PMID: 30926459 DOI: 10.1016/j.sxmr.2019.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/04/2019] [Accepted: 02/09/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION A common negative sequela of cancer treatment in men is sexual dysfunction, which can have a significant psychological impact and can contribute to feelings of depression, anxiety, and other mental health issues. Management of cancer survivors' psychological and mental well-being plays an important role in the treatment and recovery process. AIM To identify how sexual dysfunction impacts the lives of male cancer survivors and to provide clinicians with treatment recommendations specific to this patient population. METHODS A total of 51 peer-reviewed publications related to sexual dysfunction in male cancer survivors were selected for analysis. Sources were chosen based on relevance to current cancer therapies, causes and psychological impacts of sexual dysfunction, and treatment recommendations for clinicians caring for cancer survivors. PubMed search terms included "sexual dysfunction," "cancer survivorship," and "male cancer survivors." MAIN OUTCOME MEASURES Measures of sexual dysfunction were based on cancer survivors reporting inadequate erectile capacity for penetrative sexual intercourse, decreased sensitivity of the genitalia, or inability to enjoy sex. RESULTS AND CONCLUSIONS Sexual dysfunction was present in male cancer survivors from diverse ages, cancer diagnoses, and treatments of cancer. Many of the men surveyed presented with psychological distress resulting from their posttreatment sexual dysfunction. This had a significant negative impact on their sexual self-esteem, body image, and mental health. Sexual and social development was delayed in survivors of childhood cancer. Healthcare practitioners should initiate conversations with patients regarding the potential for sexual dysfunction at the time of cancer diagnosis and throughout treatment and follow-up. Physical symptoms of sexual dysfunction should be treated, whenever possible, using phosphodiesterase 5 inhibitors or other interventions, and all cancer survivors presenting with psychological distress related to sexual dysfunction should be offered professional counseling. Twitchell DK, Wittmann DA, Hotaling JM, et al. Psychological Impacts of Male Sexual Dysfunction in Pelvic Cancer Survivorship. Sex Med Rev 2019;7:614-626.
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Affiliation(s)
| | | | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
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30
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Chambers SK, Occhipinti S, Stiller A, Zajdlewicz L, Nielsen L, Wittman D, Oliffe JL, Ralph N, Dunn J. Five-year outcomes from a randomised controlled trial of a couples-based intervention for men with localised prostate cancer. Psychooncology 2019; 28:775-783. [PMID: 30716188 DOI: 10.1002/pon.5019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/20/2019] [Accepted: 01/28/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Psychosexual morbidity is common after prostate cancer treatment, however, long-term prospective research is limited. We report 5-year outcomes from a couples-based intervention in dyads with men treated for localised prostate cancer with surgery. METHODS A randomised controlled trial was conducted involving 189 heterosexual couples, where the man received a radical prostatectomy for prostate cancer. The trial groups were peer support vs. nurse counselling versus usual care. Primary outcomes were sexual adjustment, unmet sexual supportive care needs, masculine self-esteem, marital satisfaction, and utilisation of erectile aids at 2-, 3-, 4- and 5-year follow-up. RESULTS The effects of the interventions varied across the primary outcomes. Partners in the peer group had higher sexual adjustment than those in the usual care and nurses group at 2 and 3 years (P = 0.002-0.035). Men in usual care had lower unmet sexual supportive care needs than men in the peer and nurse groups (P = 0.001; P = 0.01) at 3 years. Women in usual care had lower sexual supportive care needs than women in the peer group at 2 and 3 years (P = 0.038; P = 0.001). Men in the peer and nurse group utilised sexual aids more than men in usual care; at 5 years 54% of usual care men versus 87% of men in peer support and 80% of men in the nurse group. CONCLUSION Peer and nurse-administered psychosexual interventions have potential for increasing men's adherence to treatments for erectile dysfunction. Optimal effects may be achieved through an integrated approach applying these modes of support.
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Affiliation(s)
- Suzanne K Chambers
- Faculty of Health, University of Technology Sydney, Sydney, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Stefano Occhipinti
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Anna Stiller
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia
| | - Leah Zajdlewicz
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia
| | - Lisa Nielsen
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia
| | | | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Nicholas Ralph
- Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, Australia.,Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Australia.,School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Jeff Dunn
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Australia
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Lynch O, O'Donovan A, Murphy PJ. Addressing treatment-related sexual side effects among cancer patients: Sub-optimal practice in radiation therapy. Eur J Cancer Care (Engl) 2019; 28:e13006. [PMID: 30740795 DOI: 10.1111/ecc.13006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/27/2018] [Accepted: 01/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sexual side effects of treatment are common among cancer patients receiving radiation therapy. Little attention has been given to the role of radiation therapists (RTs) in managing sexual issues. The current study sought to address this by assessing the provision of care for sexual issues by RTs in Ireland. METHODS Cross-sectional data were collected using an online questionnaire. Measures included: participant characteristics; sexuality-related practice; knowledge, awareness and confidence in dealing with sexual issues; the sexual attitudes and beliefs survey; and opinions as to the "ideal" management of sexual issues. RESULTS Discussion of sexual issues with patients was rare, and most participants (N = 46) did not feel these issues were addressed effectively in their departments. Barriers to the discussion of sexual issues included low knowledge, awareness and confidence; perceptions of professional role boundaries; and concerns about personal and patient discomfort. Nonetheless, participants indicated that RTs should ideally be equipped to discuss sexual side effects of treatment, as they would any other side effect. CONCLUSION This study has identified a sub-optimal provision of care for sexual issues by RTs. Training is needed if RTs are to effectively support the work of the multidisciplinary team in this area.
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Affiliation(s)
- Orlaith Lynch
- Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland
| | - Anita O'Donovan
- Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland
| | - Patrick J Murphy
- Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland.,Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Ireland
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Pompe RS, Krüger A, Preisser F, Karakiewicz PI, Michl U, Graefen M, Huland H, Tilki D. The Impact of Anxiety and Depression on Surgical and Functional Outcomes in Patients Who Underwent Radical Prostatectomy. Eur Urol Focus 2018; 6:1199-1204. [PMID: 30606686 DOI: 10.1016/j.euf.2018.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/26/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depression and anxiety are associated with worse surgical outcomes and higher complication rates among various types of general or orthopedic surgeries. OBJECTIVE To assess the impact of depression and anxiety on surgical, oncological, and functional outcomes in radical prostatectomy (RP) patients. DATA, SETTING, AND PARTICIPANTS Retrospective analysis of 5862 RP patients (2014-2016). INTERVENTION RP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline depression and anxiety were assessed using the Patient Health Questionnaire-4 (PHQ-4) and categorized into 0-2 (normal), 3-5 (mild), and ≥6 (moderate to severe) points. Surgical outcomes included length of hospital stay (LOS), blood loss, and complications (Clavien-Dindo grading). Functional outcomes included urinary incontinence (UI) and erectile dysfunction (ED). Oncological outcomes focused on biochemical recurrence (BCR). Kaplan-Meier plots, multivariable logistic analyses, and Cox regression analyses were used. RESULTS AND LIMITATIONS Overall, 28% patients had abnormal PHQ-4 scores and 8% a score ≥6 points. Higher PHQ-4 was significantly associated with worse surgical outcomes (longer LOS and higher complication rates) and higher risk for UI. No statistically significant difference was found for ED. However, we observed a higher use of phosphodiesterase type 5 inhibitors and intracavernous injection therapies among men with PHQ-4 score of ≥3. BCR was not affected by PHQ-4. The main limitations are the retrospective design as well as the lack of information on concomitant medications or follow-up PHQ-4 scores. CONCLUSIONS Higher PHQ-4 scores are significantly associated with worse surgical outcomes and higher risk for UI. Our study highlights the importance of preoperative depression and anxiety assessment to optimize quality of life and to reduce health-related costs. PATIENT SUMMARY Patients with preoperative depression or anxiety are at higher risk for postoperative complications and urinary incontinence after radical prostatectomy.
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Affiliation(s)
- Raisa S Pompe
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Krüger
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Preisser
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Uwe Michl
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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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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Orom H, Biddle C, Underwood W, Nelson CJ. Worse Urinary, Sexual and Bowel Function Cause Emotional Distress and Vice Versa in Men Treated for Prostate Cancer. J Urol 2018; 199:1464-1469. [PMID: 29288122 PMCID: PMC7197257 DOI: 10.1016/j.juro.2017.12.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE Definitive therapy for prostate cancer (eg surgery or radiotherapy) often has side effects, including urinary, sexual and bowel dysfunction. The purpose of this study was to test whether urinary, sexual and bowel functions contribute to emotional distress during the first 2 years after treatment and whether distress may in turn decrease function. MATERIALS AND METHODS The study participants were 1,148 men diagnosed with clinically localized disease who were treated with surgery (63%) or radiotherapy (37%). Urinary, sexual and bowel functions were assessed with EPIC (Expanded Prostate Cancer Index Composite). Emotional distress was assessed with the NCCN® (National Comprehensive Cancer Network®) Distress Thermometer. Assessment time points were before treatment, and 6 weeks, and 6, 12, 18 and 24 months after treatment. We used time lagged multilevel models to test whether physical function predicted emotional distress and vice versa. RESULTS Men with worse urinary, bowel and sexual functions reported more emotional distress than others at subsequent time points. The relationships were bidirectional. Men who reported worse distress also reported worse urinary, bowel and sexual functions at subsequent time points. CONCLUSIONS Clinicians supported by practice and payer policies should screen for and facilitate the treatment of side effects and heightened emotional distress to improve well-being in survivors of prostate cancer. These interventions may be cost-effective, given that emotional distress can negatively impact functioning across life domains.
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Olsson M, Steineck G, Enskär K, Wilderäng U, Jarfelt M. Sexual function in adolescent and young adult cancer survivors—a population-based study. J Cancer Surviv 2018; 12:450-459. [DOI: 10.1007/s11764-018-0684-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
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Decreasing suicide risk among patients with prostate cancer: Implications for depression, erectile dysfunction, and suicidal ideation screening. Urol Oncol 2018; 36:60-66. [DOI: 10.1016/j.urolonc.2017.09.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/03/2017] [Accepted: 09/05/2017] [Indexed: 11/20/2022]
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Boeri L, Capogrosso P, Ventimiglia E, Cazzaniga W, Pederzoli F, Gandaglia G, Finocchio N, Dehò F, Briganti A, Montanari E, Montorsi F, Salonia A. Depressive Symptoms and Low Sexual Desire after Radical Prostatectomy: Early and Long-Term Outcomes in a Real-Life Setting. J Urol 2018; 199:474-480. [DOI: 10.1016/j.juro.2017.08.104] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Luca Boeri
- Unit of Urology, Division of Experimental Oncology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Unit of Urology, Division of Experimental Oncology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Eugenio Ventimiglia
- Unit of Urology, Division of Experimental Oncology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Unit of Urology, Division of Experimental Oncology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Filippo Pederzoli
- Unit of Urology, Division of Experimental Oncology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology, Division of Experimental Oncology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Nadia Finocchio
- Unit of Urology, Division of Experimental Oncology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Federico Dehò
- Unit of Urology, Division of Experimental Oncology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Unit of Urology, Division of Experimental Oncology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Unit of Urology, Division of Experimental Oncology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
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Exploring the Optimal Erectile Function Domain Score Cutoff That Defines Sexual Satisfaction After Radical Prostatectomy. J Sex Med 2017; 14:804-809. [PMID: 28583341 DOI: 10.1016/j.jsxm.2017.04.672] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/15/2017] [Accepted: 04/24/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The International Index of Erectile Function (IIEF) is the gold standard validated instrument for defining erectile function (EF) and its response to treatment. The EF domain (EFD) contains six questions and is a sensitive and specific measurement of treatment-related changes in EF. The EFD score has been widely used as a primary assessment end point for clinical trials of EF recovery after radical prostatectomy (RP). Various EFD scores have been used to define functional erections. Recently, an EFD score of at least 22 has been used as a threshold in major post-RP penile rehabilitation studies. AIM To define the EFD score that optimally defines "functional" erections after RP. METHODS We assessed men 24 months after RP using the IIEF and specifically analyzed the scores of the EFD and intercourse satisfaction domain (ISD). MAIN OUTCOME MEASURES We used two questions on satisfaction (score = 0-5) and enjoyment (score = 0-5) from the ISD to classify IS (score = 0-10). We tested the following intercourse satisfaction classifications: ISD score equal to 10, ISD score of at least 8, and a score of at least 4 for the ISD questions on satisfaction and enjoyment. We used the classification that produced the largest area under the curve (AUC) using a receiver operating characteristic (ROC) curve. Then, we used a three-step process to determine the optimal EFD score cutoff using sensitivity and specificity analysis. RESULTS One hundred seventy-eight men had an average age at RP of 58 ± 7 years and a 24-month EFD score of 20 ± 9. Sixty-four percent had complete nerve-sparing surgery, 35% had partial nerve-sparing surgery, and 1% had the nerves fully resected. Thirty-three percent had laparoscopic RP and 67% had open RP. The ROC curves produced AUCs of 0.80 (ISD score = 10), 0.85 (ISD score ≥ 8), and 0.86 (ISD scores for satisfaction and enjoyment ≥ 4; P < .001 for all comparisons). Using the IS criterion of ISD scores for satisfaction and enjoyment of at least 4 (largest AUC), the sensitivity and specificity values were 0.89 and 0.66 for an ESD score equal to 22, 0.78 and 0.71 for a score equal to 23, 0.78 and 0.80 for a score equal to 24, 0.77 and 0.82 for a score equal to 25, and 0.73 and 0.85 for a score equal to 26. The scores of 24 and 25 met the criteria outlined in the first two steps of analysis. The score of 24 was selected as the cutoff using face valid judgment and the previous literature. CONCLUSION These data support an EFD score of 24 as a valid cutoff defining "functional" erection in men with erectile dysfunction after RP. These data are important for clinicians in counseling patients and to researchers to define inclusion criteria and treatment end points for trials of erectile dysfunction after RP. Terrier JE, Muhall JP, Nelson CJ. Exploring the Optimal Erectile Function Domain Score Cutoff That Defines Sexual Satisfaction After Radical Prostatectomy. J Sex Med 2017;14:804-809.
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Mériaux E, Joly F. Cancer de la prostate : effets secondaires des traitements sur la masculinité (identité masculine, fertilité, sexualité). PSYCHO-ONCOLOGIE 2017. [DOI: 10.1007/s11839-017-0632-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Brotto LA, Dunkley CR, Breckon E, Carter J, Brown C, Daniluk J, Miller D. Integrating Quantitative and Qualitative Methods to Evaluate an Online Psychoeducational Program for Sexual Difficulties in Colorectal and Gynecologic Cancer Survivors. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:645-662. [PMID: 27592509 DOI: 10.1080/0092623x.2016.1230805] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Sexual health is an integral component of quality of life for cancer survivors, and is often negatively impacted by treatment. Geographic limitations often prohibit survivors from accessing sexual health programs designed to address their needs. This study examined the efficacy of an online, 12-week psychoeducational program, which included elements of mindfulness meditation, for sexual difficulties in survivors of colorectal or gynecologic cancer. Complete pre- and postintervention data were available for 46 women (mean age 55.0, SD 9.6) and 15 men (mean age 59.7, SD 6.8). Women experienced significant improvements in sex-related distress (p < .001), sexual function (p < .001 and p < .01), and mood (p < .001); these results were maintained at six months follow-up. Men's improvement in desire was not significant (p = .06), whereas intercourse satisfaction was (p < .05) immediately after the program, but not at follow-up. In order to more fully explore women's experiences, interviews were carried out with six participants and analyzed using narrative inquiry. Women shared a feeling of renewed hope for regaining their sex lives, and expressed that they would have valued an interactive component to the program. These findings suggest that an online, unidirectional psychoeducational program is feasible, and may be effective for women survivors of gynecologic and colorectal cancer, but further work is needed to ensure that online interventions address the sexual health needs of male survivors.
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Affiliation(s)
- Lori A Brotto
- a Department of Gynaecology , University of British Columbia , Vancouver , BC , Canada
| | - Cara R Dunkley
- b Department of Psychology , University of British Columbia , Vancouver , BC , Canada
| | - Erin Breckon
- c Department of Educational and Counselling Psychology, and Special Education , University of British Columbia , Vancouver , BC , Canada
| | - Jeanne Carter
- d Departments of Surgery and Psychiatry , Memorial Sloan Kettering Cancer Center , New York , New York , USA
| | - Carl Brown
- e Division of General Surgery , St. Paul's Hospital , Vancouver , BC , Canada
| | - Judith Daniluk
- c Department of Educational and Counselling Psychology, and Special Education , University of British Columbia , Vancouver , BC , Canada
| | - Dianne Miller
- a Department of Gynaecology , University of British Columbia , Vancouver , BC , Canada
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Patient-provider communication about sexual concerns in cancer: a systematic review. J Cancer Surviv 2016; 11:175-188. [PMID: 27858322 DOI: 10.1007/s11764-016-0577-9] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/04/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Cancer survivors' needs around sexual concerns are often unmet. The primary objective of this systematic review was to examine the prevalence of and factors associated with patient-provider communication about sexual concerns in cancer. METHODS Using PRISMA guidelines, we searched PubMed/MEDLINE, PsychInfo, and CINAHL databases for peer-reviewed quantitative research papers (2000-2015) in cancer samples. Search terms across three linked categories were used (sexuality, communication, and cancer). The National Comprehensive Cancer Network (NCCN) Sexual Function Guidelines were used as a framework to categorize communication reported in each study. RESULTS Twenty-nine studies from 10 countries (29 % in USA) were included. Studies assessed patients only (21), providers only (4), and both (4). Communication measures differed across studies and many lacked validity data. When reported by patients or providers, the average prevalence of discussing potential treatment effects on sexual function was 50 (60 % for men and 28 % for women) and 88 %, respectively. As reported by patients or providers, respectively, assessing patients' sexual concerns (10 and 21 %) and offering treatments (22 and 17 %) were measured in fewer studies and were reported less frequently. Both patients and providers (28 and 32 %, respectively) reported a low prevalence of other non-specific communication. Greater prevalence of communication was associated with male patient gender and more years of provider experience. CONCLUSIONS Sexual issues go unaddressed for many cancer survivors, particularly women. Both patient and provider interventions are needed. IMPLICATIONS FOR CANCER SURVIVORS Enhancing patient-provider communication about sexual concerns through evidence-based interventions could improve patient sexual function and quality of life.
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Molina-Leyva A, Molina-Leyva I, Almodovar-Real A, Ruiz-Carrascosa JC, Naranjo-Sintes R, Jimenez-Moleon JJ. Prevalence and Associated Factors of Erectile Dysfunction in Patients With Moderate to Severe Psoriasis and Healthy Population: A Comparative Study Considering Physical and Psychological Factors. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:2047-2055. [PMID: 27270734 DOI: 10.1007/s10508-016-0757-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/26/2016] [Accepted: 04/08/2016] [Indexed: 06/06/2023]
Abstract
Recent studies have shown that psoriasis is associated with an increased prevalence of erectile dysfunction. To our knowledge, no comparative study has considered simultaneously the role of organic factors and psychological factors in this process. We performed a prospective case series study matched by age to explore the prevalence of erectile dysfunction in psoriasis patients compared to a healthy population and to investigate the role of anxiety, depression, and cardiovascular risk factors in the relationship between psoriasis and erectile dysfunction. The healthy group was matched by frequency to cases by age. Seventy-nine patients with moderate to severe psoriasis and 79 healthy controls participated in the study. Participants completed the Massachusetts General Hospital Sexual Functioning Questionnaire and the Hospital Anxiety and Depression Scale. Psoriasis patients had an increased prevalence of erectile dysfunction in comparison to controls, 34.2 vs. 17.7 % (p < .05). Multivariate analysis showed a significant association between erectile dysfunction and age, smoking and anxiety/depression, but not with psoriasis per se. In conclusion, the higher prevalence of smoking and anxiety/depression among patients with moderate to severe psoriasis probably explains the higher prevalence of erectile dysfunction in this population.
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Affiliation(s)
- Alejandro Molina-Leyva
- Department of Dermatology, Complejo Hospitalario Torrecárdenas, Almeria, Spain.
- Department of Dermatology, Complejo Hospitalario Universitario Granada, Avenida Doctor Oloriz 16, 18012, Granada, Spain.
| | - Ignacio Molina-Leyva
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | | | - Jose Carlos Ruiz-Carrascosa
- Department of Dermatology, Complejo Hospitalario Universitario Granada, Avenida Doctor Oloriz 16, 18012, Granada, Spain
| | - Ramon Naranjo-Sintes
- Department of Dermatology, Complejo Hospitalario Universitario Granada, Avenida Doctor Oloriz 16, 18012, Granada, Spain
| | - Jose Juan Jimenez-Moleon
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública, Madrid, Spain
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Emanu JC, Avildsen IK, Nelson CJ. Erectile dysfunction after radical prostatectomy: prevalence, medical treatments, and psychosocial interventions. Curr Opin Support Palliat Care 2016; 10:102-7. [PMID: 26808052 DOI: 10.1097/spc.0000000000000195] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This review will discuss erectile dysfunction in prostate cancer patients following radical prostatectomy . It will focus on the prevalence and current treatments for erectile dysfunction as well as the emotional impact of erectile dysfunction and the current psychosocial interventions designed to help patients cope with this side effect. RECENT FINDINGS Although there is a large discrepancy in prevalence rates of erectile dysfunction after radical prostatectomy, several recent studies have cited rates as high as 85%. The concept of 'penile rehabilitation' is now the standard of practice to treat erectile dysfunction following radical prostatectomy. However, many men avoid seeking help or utilizing erectile dysfunction treatments. This avoidance is related to the shame, frustration, and distress many men with erectile dysfunction and their partners experience. Recent psychosocial interventions have been developed to facilitate the use of treatments and help men cope with erectile dysfunction. These interventions have shown initial promise, however, continued intervention development is needed to reduce distress and improve long-term erectile function outcomes. SUMMARY Erectile dysfunction is a significant problem following prostate cancer surgery. Although there are effective medical treatments, the development of psychosocial interventions should continue to evolve to maximize the assistance we can give to men and their partners.
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Affiliation(s)
- Jessica C Emanu
- Department of Psychiatry and Behavioral Sciences Memorial Sloan Kettering Cancer Center, New York, USA
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Abstract
Erectile dysfunction is a multidimensional but common male sexual dysfunction that involves an alteration in any of the components of the erectile response, including organic, relational and psychological. Roles for nonendocrine (neurogenic, vasculogenic and iatrogenic) and endocrine pathways have been proposed. Owing to its strong association with metabolic syndrome and cardiovascular disease, cardiac assessment may be warranted in men with symptoms of erectile dysfunction. Minimally invasive interventions to relieve the symptoms of erectile dysfunction include lifestyle modifications, oral drugs, injected vasodilator agents and vacuum erection devices. Surgical therapies are reserved for the subset of patients who have contraindications to these nonsurgical interventions, those who experience adverse effects from (or are refractory to) medical therapy and those who also have penile fibrosis or penile vascular insufficiency. Erectile dysfunction can have deleterious effects on a man's quality of life; most patients have symptoms of depression and anxiety related to sexual performance. These symptoms, in turn, affect his partner's sexual experience and the couple's quality of life. This Primer highlights numerous aspects of erectile dysfunction, summarizes new treatment targets and ongoing preclinical studies that evaluate new pharmacotherapies, and covers the topic of regenerative medicine, which represents the future of sexual medicine.
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Erectile dysfunction after radical prostatectomy: Effect of quality of life and psychology. Rev Int Androl 2015. [DOI: 10.1016/j.androl.2014.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Goonewardene SS, Persad R. Psychosexual care in prostate cancer survivorship: a systematic review. Transl Androl Urol 2015; 4:413-20. [PMID: 26816840 PMCID: PMC4708596 DOI: 10.3978/j.issn.2223-4683.2015.08.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/05/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prostate cancer (PC) is the most common cancer in men. Due to improvements in medical care, the number of PC survivors is increasing. Current literature demonstrates survivors have significant unmet needs including psychosexual care. We assess patients psychosexual needs by systematic review of literature over the past 20 years up to May 2015 in order to see what issues need to be addressed within psychosexual care. METHODS A systematic review was conducted on PC survivorship and psychosexual care. The search strategy aimed to identify all references related to PC survivorship programme components (parts of survivorship programmes) AND survivorship AND psychosexual concerns. Search terms used were as follows: (PC OR prostate neoplasms) AND (survivorship OR survivor*) OR [psychosexual impairment or sexual dysfunction or erectile dysfunction (ED)] AND [comorbidity or quality of life (QoL)]. RESULTS The systematic review identified 17 papers, examining unmet needs in psychosexual care post PC therapy. CONCLUSIONS These findings of this review may change psychosexual care of PC survivors, as national and international guidance is needed.
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Affiliation(s)
- Sanchia Shanika Goonewardene
- 1 Guys and St Thomas Hospitals London, Kings College London, London, UK ; 2 North Bristol NHS Trust, Bristol, UK
| | - Raj Persad
- 1 Guys and St Thomas Hospitals London, Kings College London, London, UK ; 2 North Bristol NHS Trust, Bristol, UK
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Tavlarides AM, Ames SC, Thiel DD, Diehl NN, Parker AS. Baseline and follow-up association of the MAX-PC in Men with newly diagnosed prostate cancer. Psychooncology 2015; 24:451-7. [PMID: 24953309 PMCID: PMC4326594 DOI: 10.1002/pon.3605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this paper is to conduct a prospective, longitudinal study employing the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) to examine the baseline and follow-up association of prostate cancer (PCa)-specific anxiety, health-related quality of life (HRQOL), and PCa aggressiveness in men with newly-diagnosed PCa undergoing prostatectomy at our institution. METHODS From our prospective PCa registry, we identified a total of 350 men with newly-diagnosed PCa who completed the MAX-PC and the Expanded Prostate Cancer Index Composite (EPIC) at baseline and one-year following surgery. Scores on both measures were compared with clinical measure and demographics using the Wilcoxon Rank Sum, Fisher's exact, and Cochran-Armitage Trend tests. Spearman test was used to assess correlation at between the MAX-PC and EPIC at baseline and one-year. RESULTS Baseline overall MAX-PC measures were correlated with measures at one-year (r=0.5479, p<0.001). Those reporting high anxiety at one-year were more likely to have Gleason score>6 (p=0.004), T-Stage ≥ 2C disease (p=0.004), and a postoperative prostate-specific antigen (PSA)>0.1 (p=0.002); however, this did not apply to all anxious patients. Baseline EPIC sexual function scores were predictive of follow-up EPIC sexual function scores as well (r=0.5790, p<0.001). Depression was noted as a problem in 16% of patients at follow-up. CONCLUSIONS Our data suggests that the MAX-PC could be used at baseline as a tool to determine who may benefit from psychological intervention pre-PCa and post-PCa treatment. In terms of individualized medicine, behavioral therapy may be the most beneficial in improving HRQOL for younger patients, those with advanced stage disease, and more specifically those whose anxiety outweighs their actual prognosis.
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Affiliation(s)
| | - Steven C. Ames
- Division of Hematology and Oncology, Mayo Clinic, FL, USA
| | - David D. Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Nelson CJ, Lacey S, Kenowitz J, Pessin H, Shuk E, Roth AJ, Mulhall JP. Men's experience with penile rehabilitation following radical prostatectomy: a qualitative study with the goal of informing a therapeutic intervention. Psychooncology 2015; 24:1646-54. [PMID: 25707812 DOI: 10.1002/pon.3771] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 01/06/2015] [Accepted: 01/15/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Erectile rehabilitation (ER) following radical prostatectomy (RP) is considered an essential component to help men regain erectile functioning; however, many men have difficulty adhering to this type of program. This qualitative study explored men's experience with ER, erectile dysfunction (ED), and ED treatments to inform a psychological intervention designed to help men adhere to ER post-RP. METHODS Thirty men, 1-to-3-years post-RP, who took part in an ER program, participated in one of four focus groups. Thematic analysis was used to identify the primary themes. RESULTS Average age was 59 years (standard deviation = 7); mean time since surgery was 26 months (standard deviation = 6). Six primary themes emerged: (1) frustration with the lack of information about postsurgery ED; (2) negative emotional impact of ED and avoidance of sexual situations; (3) negative emotional experience with penile injections and barriers leading to avoidance; (4) the benefit of focusing on the long-term advantage of ER versus short-term anxiety; (5) using humor to help cope; and (6) the benefit of support from partners and peers. CONCLUSIONS Men's frustration surrounding ED can lead to avoidance of sexual situations and ED treatments, which negatively impact men's adherence to an ER program. The theoretical construct of acceptance and commitment therapy was used to place the themes into a framework to conceptualize the mechanisms underlying both avoidance and adherence in this population. As such, acceptance and commitment therapy has the potential to serve as a conceptual underpinning of a psychological intervention to help men reduce avoidance to penile injections and adhere to an ER program.
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Affiliation(s)
- Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephanie Lacey
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joslyn Kenowitz
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hayley Pessin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elyse Shuk
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Dowsett GW, Lyons A, Duncan D, Wassersug RJ. Flexibility in Men's Sexual Practices in Response to Iatrogenic Erectile Dysfunction after Prostate Cancer Treatment. Sex Med 2014; 2:115-20. [PMID: 25356308 PMCID: PMC4184491 DOI: 10.1002/sm2.32] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Prostate cancer (PCa) treatments are associated with a high incidence of erectile dysfunction (ED). Interventions to help men with iatrogenic ED have largely focused on penile tumescence adequate for vaginal penetration. Less research has been undertaken on sex practices other than penile/vaginal intercourse. AIM The aim of this study was to explore forms of sexual practice engaged in by men following treatment for PCa. We focused in particular on anal intercourse (AI) as practiced by both nonheterosexual (i.e., gay-identified men and other men who have sex with men) and heterosexual men. We sought to determine how common AI was subsequent to PCa treatment and how flexible AI practitioners were in their modes (e.g., from insertive to receptive) when faced with iatrogenic ED. METHODS An international online survey was conducted in 2010-2011 of men treated for PCa, where participants (N = 558) were asked explicitly about their sexual practices before and after PCa treatment. MAIN OUTCOME MEASURES The outcome measures were the numbers and percentages of men who practiced AI before and after PCa treatment as well as the percentage who changed AI practice after PCa treatment. RESULTS Five hundred twenty-six men (90 nonheterosexual men; 436 heterosexual men) answered questions on AI practices. A proportion of nonheterosexual (47%) and heterosexual men (7%) practiced AI following PCa treatment, and did so in all modes (insertive, receptive, and "versatile"). Many nonheterosexual men continued to be sexually active in the face of iatrogenic ED by shifting from the insertive to receptive modes. A few men, both heterosexual and nonheterosexual, adopted AI for the first time post-PCa treatment. CONCLUSIONS Flexibility in sexual practice is possible for some men, both nonheterosexual and heterosexual, in the face of iatrogenic ED. Advising PCa patients of the possibilities of sexual strategies that include AI may help them in reestablishing a sex life that is not erection dependent. Dowsett GW, Lyons A, Duncan D, and Wassersug RJ. Flexibility in men's sexual practices in response to iatrogenic erectile dysfunction after prostate cancer treatment. Sex Med 2014;2:115-120.
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Affiliation(s)
- Gary W Dowsett
- Australian Research Centre in Sex, Health and Society, La Trobe University Melbourne, Victoria, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University Melbourne, Victoria, Australia
| | - Duane Duncan
- Australian Research Centre in Sex, Health and Society, La Trobe University Melbourne, Victoria, Australia
| | - Richard J Wassersug
- Australian Research Centre in Sex, Health and Society, La Trobe University Melbourne, Victoria, Australia
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Chien CH, Chuang CK, Liu KL, Huang XY, Liu HE. Psychosocial adjustments in patients with prostate cancer from pre-diagnosis to 6 months post-treatment. Int J Nurs Pract 2014; 22:70-8. [DOI: 10.1111/ijn.12360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ching-Hui Chien
- College of Nursing; National Taipei University of Nursing and Health Sciences; Taipei Taiwan
| | - Cheng-Keng Chuang
- Division of Urology; Department of Surgery; Chang Gung Memorial Hospital; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
| | - Kuan-Lin Liu
- Division of Urology; Department of Surgery; College of Medicine; Chang Gung Memorial Hospital; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
| | - Xuan-Yi Huang
- College of Nursing; National Taipei University of Nursing and Health Sciences; Taipei Taiwan
| | - Hsueh-Erh Liu
- College of Medicine; School of Nursing; Chang Gung University; Tao-Yuan Taiwan
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