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Ferrandino MN, Espino G, Young M, Bodden E, Gahan JC. Initial Experience with an Absorbable Urologic Scaffold to Mitigate Early Urinary Incontinence following Radical Prostatectomy: A Report of 2 Cases. Urol Int 2024:1-4. [PMID: 39102800 DOI: 10.1159/000540739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 07/30/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is a frequent, known complication following robot-assisted radical prostatectomy (RARP) for prostate cancer. Urethral shortening and reduced urethral support following RARP are contributing factors. CASE PRESENTATIONS Herein, we describe a surgical approach using a novel absorbable urologic scaffold to mitigate SUI in 2 patients enrolled in an ongoing single-arm prospective study. The scaffold is designed to relieve the burden on the urinary sphincter by lengthening the effective urethra following RARP. The scaffold is placed at the anastomotic site, overlying the bladder neck and urethral stump following prostate removal and prior to the creation of the anastomosis. Both patients successfully underwent the prostatectomy and urologic scaffold placement with no reported perioperative complications. Neither patient suffered from early SUI following RARP as measured by pad weight and usage at 1 and 3 months following the procedure. CONCLUSION Early experience with the absorbable urologic scaffold suggests it could safely and effectively prevent SUI following RARP. Early and long-term results derived from the ongoing prospective study with this device will better define its potential role in the prevention of SUI.
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Affiliation(s)
| | - Gustavo Espino
- Robotic Surgery Center, Hospital Nacional, Panama City, Panama
- Department of Surgery, School of Medicine, Universidad de Panamá, Panama City, Panama
| | - Marcos Young
- Robotic Surgery Center, Hospital Nacional, Panama City, Panama
- Department of Surgery, School of Medicine, Universidad de Panamá, Panama City, Panama
| | - Elías Bodden
- Robotic Surgery Center, Hospital Nacional, Panama City, Panama
- Department of Surgery, School of Medicine, Universidad de Panamá, Panama City, Panama
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Singh F, Newton RU, Taaffe DR, Lopez P, Thavaseelan J, Brown M, Ooi E, Nosaka K, Hayne D, Galvão DA. Prehabilitative versus rehabilitative exercise in prostate cancer patients undergoing prostatectomy. J Cancer Res Clin Oncol 2023; 149:16563-16573. [PMID: 37712960 PMCID: PMC10645629 DOI: 10.1007/s00432-023-05409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE The study compared the efficacy of commencing supervised exercise in men with prostate cancer before and after prostatectomy on objective and patient-reported outcomes, hospital length of stay, and urinary incontinence. METHODS Forty-one men were randomised to a 6-week prehabilitation or rehabilitation exercise programme. Prehabilitation involved resistance and aerobic exercise thrice weekly pre-surgery, while rehabilitation comprised the same commencing 6-weeks post-surgery. Assessments included strength, function (chair rise, stair climb, 400-m, 6-m usual, fast, and backwards walk), body composition, fatigue and quality of life, undertaken at pre-surgery, early post-surgery and late post-surgery phase, with urinary incontinence (24-h pad test) assessed at 2, 6, and 12-weeks post-surgery. Intention-to-treat and sensitivity analyses were undertaken. RESULTS Of thirty-eight men (48-73 years), 29 completed all assessments with most undergoing robotic-assisted laparoscopic prostatectomy (92.1%). In the pre-surgery phase, prehabilitation improved muscle strength (leg press: 17.2 kg; chest press: 2.9 kg; p ≤ 0.001), 400-m, chair rise, 6-m fast and backward walk tests (p ≤ 0.001-0.028). Strength and function declines in the early post-surgery phase were maintained late post-surgery. Rehabilitation showed declines of these outcomes after surgery with improvement late post-surgery (leg press: 14.6 kg, p < 0.001; chest press: 6.8 kg, p < 0.001; 400-m walk: -12.0 s, p = 0.005), resulting in no difference between groups at 12 weeks. There were no significant differences between groups for patient-reported outcomes, hospital length of stay or urinary incontinence. CONCLUSION Pre-surgical exercise enhanced strength and function, protecting against post-surgery declines. Although exercise post-surgery is beneficial for recouping strength and function, where possible men undergoing prostatectomy are encouraged to exercise pre-surgery. TRIAL REGISTRATION ACTRN12617001115325 registered 31 July 2017.
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Affiliation(s)
- Favil Singh
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - Robert U Newton
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Dennis R Taaffe
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Pedro Lopez
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
| | | | - Matthew Brown
- Perth Urology Clinic, Perth, WA, Australia
- Fiona Stanley Hospital, Murdoch, WA, Australia
- UWA Medical School, University of Western Australia, Crawley, WA, Australia
| | | | - Kazunori Nosaka
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Dickon Hayne
- Fiona Stanley Hospital, Murdoch, WA, Australia
- UWA Medical School, University of Western Australia, Crawley, WA, Australia
| | - Daniel A Galvão
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
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3
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Latest Evidence on Post-Prostatectomy Urinary Incontinence. J Clin Med 2023; 12:jcm12031190. [PMID: 36769855 PMCID: PMC9917389 DOI: 10.3390/jcm12031190] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
A radical prostatectomy is frequently used as the first-line treatment for men with prostate cancer. Persistent urinary incontinence after surgery is one of the most severe adverse events. We report the results of a comprehensive literature search focused on post-prostatectomy urinary incontinence (PPI), performed by a panel of experts on non-neurogenic lower urinary tract symptoms. The data on the prevalence and timing of PPI are very heterogeneous. The etiology of PPI can be multifactorial and mainly dependent on patient characteristics, lower urinary tract function or surgical issues. The medical history with a physical examination, the use of validated questionnaires with a voiding diary and pad tests are determinants in identifying the contributing factors and choosing the right treatment. Lifestyle intervention and urinary containment are the most frequently used strategies for the conservative management of PPI, while antimuscarinics, beta-3 agonists and duloxetine (off-label) are drugs indicated to manage PPI with a concomitant overactive bladder. Surgical therapies for the management of post-prostatectomy SUI include non-adjustable trans-obturator slings in men with mild-to-moderate incontinence and an artificial urinary sphincter in men with moderate-to-severe incontinence.
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Kohada Y, Ito J, Kaiho Y, Kusumoto H, Kukimoto T, Mikami J, Hinata N, Sato M. Importance of considering interest in sex when evaluating satisfaction after robot-assisted radical prostatectomy. Int J Urol 2022; 29:446-454. [PMID: 35133043 DOI: 10.1111/iju.14813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the impact of patients' interest in sex on the satisfaction after robot-assisted radical prostatectomy, longitudinal changes of urinary and sexual functions and bothers were evaluated. METHODS A total of 101 patients underwent robot-assisted radical prostatectomy in our institution. Based on sexual interest, they were divided into the high-interest and low-interest groups. Overall satisfaction, urinary function, urinary bother, sexual function, and sexual bother were evaluated using the expanded prostate cancer index composite questionnaire preoperatively and at 1, 3, 6, and 12 months after robot-assisted radical prostatectomy. We investigated the associations between the overall satisfaction and urinary function/urinary bother/sexual function/sexual bother scores (with higher score indicating better function and less impairment). RESULTS In the high-interest group (n = 45), satisfaction correlated with high urinary function and urinary bother scores early after robot-assisted radical prostatectomy (urinary function: 1 and 3 months, urinary bother: 3 months postoperatively; P < 0.05) and then with high sexual bother score thereafter (sexual bother at 6 and 12 months after surgery; P < 0.05). Sexual function score did not correlate with satisfaction. In the low-interest group (n = 56), satisfaction correlated with high urinary function and urinary bother scores over time (urinary function: 3 and 6 months, urinary bother: at 3, 6 and 12 months postoperatively; P < 0.05). Neither sexual function nor sexual bother correlated with satisfaction postoperatively in the low-interest group. CONCLUSIONS The impact of urinary and sexual functions and bothers on patients' overall satisfaction differed between patients with high- and low-interest in sex. The patient's interest in sex should be considered when assessing satisfaction after robot-assisted radical prostatectomy.
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Affiliation(s)
- Yuki Kohada
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Jun Ito
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yasuhiro Kaiho
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hiroki Kusumoto
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takashi Kukimoto
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Jotaro Mikami
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Nobuyuki Hinata
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Makoto Sato
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Colonnello E, Limoncin E, Ciocca G, Sansone A, Mollaioli D, Balercia G, Porst H, Zhang H, Yu X, Zhang Y, Jannini EA. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2021; 10:113-129. [PMID: 34620562 DOI: 10.1016/j.sxmr.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/22/2021] [Accepted: 08/28/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The "lost penis syndrome" (LPS) is a term often used in non-clinical settings to describe the subjective perception of the loss of cutaneous and proprioceptive feelings of the male organ during vaginal penetration. Although deserving clinical attention, this syndrome did not receive any consideration in the medical literature. Notwithstanding, it represents a relatively unexceptional condition among patients in sexual medicine clinics, and it is often reported together with other sexual dysfunctions, especially delayed ejaculation, anejaculation, male anorgasmia and inability to maintain a full erection. OBJECTIVES To draft a new conceptual characterization of the LPS, defined as a lack of penile somesthetic sensations during sexual penetration due to various causes and leading to several sexual consequences in both partners. METHODS Based on an extensive literature review and physiological assumptions, the mechanisms contributing to friction during penovaginal intercourse, and their correlation to LPS, have been explored, as well as other nonanatomical factors possibly contributing to the loss of penile sensations. RESULTS Efficient penile erection and sensitivity, optimal vaginal lubrication and trophism contribute to penovaginal friction. Whenever one of these processes does not occur, loss of penile sensation defined as LPS can occur. Sociocultural, psychopathological and age-related (ie, couplepause) factors are also implicated in the etiology. Four types of LPS emerged from the literature review: anatomical and/or functional, behavioral, psychopathological and iatrogenic. According to the subtype, a wide variety of treatments can be employed, including PDE5i, testosterone replacement therapy and vaginal cosmetic surgery, as well as targeted therapy for concomitant sexual comorbidity. CONCLUSION We held up the mirror on LPS as a clinically existing multifactorial entity and provided medical features and hypotheses contributing to or causing the occurrence of LPS. In the light of a sociocultural and scientific perspective, we proposed a description and categorization of this syndrome hypothesizing its usefulness in daily clinical practice. Colonnello E, Limoncin E, Ciocca G, et al. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Elena Colonnello
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Erika Limoncin
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy; Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Giacomo Ciocca
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Andrea Sansone
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Mollaioli
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Hartmut Porst
- European Institute for Sexual Health (EISH), Hamburg, Germany
| | - Hui Zhang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PRC
| | - Xi Yu
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PRC
| | - Yan Zhang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PRC
| | - Emmanuele A Jannini
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Manne SL, Kashy D, Myers-Virtue S, Zaider T, Kissane DW, Heckman CJ, Kim I, Penedo F, Lee D. Relationship communication and the course of psychological outcomes among couples coping with localised prostate cancer. Eur J Cancer Care (Engl) 2021; 30:e13401. [PMID: 33586282 DOI: 10.1111/ecc.13401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 07/28/2020] [Accepted: 11/27/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE How couples communicate about cancer is an important predictor of psychological outcomes for men diagnosed with localised prostate cancer and their spouses. We examined the predictive role of disclosure, responsiveness, mutual avoidance, and holding back on depressive symptoms, psychological adjustment, cancer-specific distress, and cancer concerns. METHODS Eighty-one prostate cancer patients and their spouses completed measures of communication at baseline and measures of four psychological outcomes at baseline, five, 12, and 26 weeks after baseline. Dyadic growth models tested the effects of time and role on each outcome over time. RESULTS Higher disclosure and responsiveness predicted better psychological outcomes. Less mutual avoidance and holding back predicted poorer psychological outcomes. Across communication variables, individuals who engaged in poorer communication initially had poorer psychological outcomes that improved over time, whereas individuals who engaged in better communication initially maintained their more positive standing without change or changed in the positive direction. For all outcomes, those with better communication still had better psychological outcomes at six months. CONCLUSION Couples' cancer-specific relationship communication predicts their psychological outcomes. More research is needed to identify effective interventions, including a longer therapy course, individual communication training, or greater focus on addressing barriers to sharing and responsiveness.
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Affiliation(s)
- Sharon L Manne
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | - Talia Zaider
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - David W Kissane
- Department of Medicine, University of Notre Dame Australia, and Cabrini Health and Monash Health Psycho-Oncology, Monash University, Melbourne, Vic., Australia
| | | | - Isaac Kim
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Frank Penedo
- Sylvester Cancer Center, University of Miami, Miami, FL, USA
| | - David Lee
- Division of Urology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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How radical prostatectomy procedures have changed over the last 10 years in Italy: a comparative analysis based on more than 1500 patients participating in the MIRROR-SIU/LUNA and the Pros-IT CNR study. World J Urol 2020; 39:1445-1452. [PMID: 32740803 DOI: 10.1007/s00345-020-03350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy. METHODS The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients' characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND). RESULTS The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%, p < 0.001) and NS prostatectomy (58.4% vs. 52.9%, p = 0.04), but received LND less frequently (47.7% vs. 76.7%, p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS ≥ (4 + 3) and positive cancer cores ≥ 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies. CONCLUSIONS PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium-high risk diagnosed PCa.
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Relationship intimacy processes during treatment for couple-focused interventions for prostate cancer patients and their spouses. JOURNAL OF PSYCHOSOCIAL ONCOLOGY RESEARCH & PRACTICE 2019; 1. [PMID: 36237825 PMCID: PMC9554946 DOI: 10.1097/or9.0000000000000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: In a previously published trial, we compared the effect of an
intimacy-enhancing therapy (IET) and a General Health and Wellness
intervention (GHW) on psychological and relationship outcomes among men
diagnosed with localized prostate cancer and their partners. Results
suggested partial effects of IET on psychological adjustment and
relationship satisfaction. To understand these partial effects, the first
aim of this study was to evaluate self-disclosure, perceived partner
disclosure, perceived partner responsiveness, and levels of intimacy rated
after sessions, and the second aim of this study was to examine the role of
pre-treatment holding back on these intimacy processes. Methods: A total of 156 couples who participated in treatment reported on
self- and perceived partner disclosure, responsiveness, and intimacy during
sessions. Participants rated levels of holding back before treatment. Linear
growth models were estimated using multilevel modeling. Each intimacy
process variable was predicted to be a function of time, role, condition,
and all interactions among these variables. The effects of own and partner
pretreatment holding back on average intimacy process and change in intimacy
process were tested in moderated growth models. Results: Self- and perceived partner disclosure were significantly higher
during IET sessions than GHW sessions. Self-disclosure, perceived partner
disclosure, and perceived partner responsiveness increased in both IET and
GHW. Intimacy was not higher and did not increase more in IET compared with
GHW. Participants who held back reported that their partner disclosed less
to them during sessions, perceived that their partner was less responsive to
them during sessions, and reported less intimacy during sessions. Partners
of participants who held back were seen as less responsive and their
interactions were seen as less intimate. Conclusions: Although IET focused on enhancing couples’ responsiveness and
intimacy, it did not have a stronger effect on these processes during
sessions than GHW. The lack of an effect may, in part, be because of the
fact that IET did not help those couples who may have been in the greatest
need for it because they held back more.
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NOUHI M, MOUSAVI SM, OLYAEEMANESH A, SHAKSISALIM N, AKBARI SARI A. Long-Term Clinical Outcomes of Radical Prostatectomy versus Watchful Waiting in Localized Prostate Cancer Patients: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:566-578. [PMID: 31110967 PMCID: PMC6500545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The present study aimed to compare the long-term clinical and functional outcomes of patients with clinically localized prostate cancer treated with radical prostatectomy compared to the watchful waiting. METHODS PubMed, Cochrane Central Register of Controlled Trials and reference lists of relevant marker studies were scrutinized from inception to Jan 2018. Two reviewers conducted data abstraction and quality assessment of included trials independently. Quality of included studies were assessed by using Cochrane checklist. Inverse-variance and Mantel-Haenszel estimates under random effects model were used to pool results as relative risks with 95% confidence interval. Heterogeneity was assessed by using I2. RESULTS Three randomized controlled trials with 1568 participants were included. Compared to watchful waiting, radical prostatectomy had no significant effect on all-cause mortality at 12-year follow-up. However, radical prostatectomy had significant effect on reducing prostate-cause mortality at 12-year follow-up. We found significant lower prostate-cause mortality in patients with PSA>10 and GS≥7 scores who had undergone radical prostatectomy compared with patients in watchful waiting group. In addition, younger patients undergoing surgery developed lower distant metastases rate compared to another approach. Watchful waiting had a significant effect on erectile and urinary incontinence during 2 years. CONCLUSION There was no significant difference between radical prostatectomy and watchful waiting on all-cause mortality. However, the radical prostatectomy was associated with statistically lower prostate-cause mortality and metastases rates. Compared with older men, younger men experienced better clinical outcomes. Moreover, watchful waiting had better effect on reducing erectile dysfunction and urinary incontinence among patients during 2 years compared to radical prostatectomy.
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Affiliation(s)
- Mojtaba NOUHI
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran,Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Masood MOUSAVI
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza OLYAEEMANESH
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran,National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasser SHAKSISALIM
- Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali AKBARI SARI
- Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
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10
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Manne SL, Kashy DA, Zaider T, Kissane D, Lee D, Kim IY, Heckman CJ, Penedo FJ, Murphy E, Virtue SM. Couple-focused interventions for men with localized prostate cancer and their spouses: A randomized clinical trial. Br J Health Psychol 2019; 24:396-418. [PMID: 30852854 DOI: 10.1111/bjhp.12359] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/11/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Few couple-focused interventions have improved psychological and relationship functioning among men diagnosed with localized prostate cancer and their spouses. This study compared the impact of intimacy-enhancing therapy (IET), a general health and wellness intervention (GHW), and usual care (UC) on the psychological and relationship functioning of localized prostate cancer patients and their partners. Relationship length, relationship satisfaction, and patient masculinity were evaluated as moderators. DESIGN This study was a randomized clinical trial with three study arms and four assessment time points. METHODS A total of 237 patients and partners were randomly assigned to receive IET, GHW, or UC. Participants completed measures of psychological functioning and relationship satisfaction at baseline, 5 weeks, 3 months, and 6 months post-baseline. Primary outcomes were psychological adjustment, depression, cancer-specific distress, cancer concerns, and relationship satisfaction. RESULTS Spouses in IET showed greater increases in relationship satisfaction than spouses in GHW and UC between the baseline and 5-week follow-up. Among patients in longer relationships, significant increases in psychological adjustment were found in both treatments compared to UC. Among spouses in longer relationships, psychological adjustment increased in both IET and UC but declined in GHW. CONCLUSIONS Intimacy-enhancing therapy did not show an impact on general or cancer-specific distress, but did show an early impact on relationship satisfaction among spouses. IET was superior to UC for patients in longer relationships. It will be important for researchers to understand which couple-focused interventions benefits both patients and spouses and to identify characteristics of patients, partners, and couples who may not benefit from psychological treatments. Statement of contribution What is already known on this subject? Men diagnosed with localized prostate cancer report lower health-related quality of life and both patients and spouses report elevated distress. Relationship communication plays a role in couples' psychological adaptation to prostate cancer. Couple-focused interventions have illustrated an impact on relationship communication. There are no studies comparing different couple-focused interventions. What does this study add? Intimacy-enhancing therapy was not superior to no treatment or a comparison treatment for the broad range of psychological and relationship outcomes. Intimacy-enhancing therapy was superior to no treatment for patients in longer-term relationship. The general health and wellness intervention was not beneficial for men in shorter relationships and for men who did not endorse traditional masculine norms.
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Affiliation(s)
- Sharon L Manne
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Talia Zaider
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
| | - David Kissane
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Psychiatry, Monash Medical Center, Monash University, Clayton, Victoria, Australia
| | - David Lee
- Penn Urology, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Isaac Y Kim
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.,Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Frank J Penedo
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Evangelynn Murphy
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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Manne S, Kashy DA, Zaider T, Lee D, Kim IY, Heckman C, Penedo F, Kissane D, Virtue SM. Interpersonal processes and intimacy among men with localized prostate cancer and their partners. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2018; 32:664-675. [PMID: 29771551 PMCID: PMC6072581 DOI: 10.1037/fam0000404] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The present study focused on intimacy processes in the relationships of men diagnosed with localized prostate cancer and their partners. Using the actor-partner interdependence model (APIM), we examined the interpersonal process model of intimacy, which proposes associations between self- and perceived partner disclosure about cancer and perceived partner responsiveness as predictors of global relationship intimacy. The study's outcomes were patients' and spouses' ratings of global relationship intimacy. Both actor (my disclosure predicts my intimacy) and partner (my partner's disclosure predicts my intimacy) effects were examined, as well as possible moderating effects for cancer-related concerns. Two hundred and nine couples in which one or both partners reported elevated cancer-specific distress completed measures of self- and perceived partner disclosure and perceived partner responsiveness regarding discussions about prostate cancer, global relational intimacy, and cancer-related concerns. Results were consistent with the interpersonal process model of intimacy in that perceived responsiveness mediated the association between self- and perceived partner disclosure about cancer and global relational intimacy for both patients and spouses. Results also indicated moderation of the links between disclosure and relational intimacy by level of patient cancer-related concerns such that the links were stronger when concerns were higher. Finally, there was also evidence of moderated mediation such that indirect effects of disclosure on relational intimacy via perceived partner responsiveness were stronger when concerns were higher. Interventions for distressed couples coping with prostate cancer would benefit from focusing on facilitating disclosure and responsiveness, particularly among distressed couples who report cancer concerns. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - David Lee
- Perelman School of Medicine, University of Pennsylvania
| | - Isaac Y Kim
- Department of Surgery, Rutgers Cancer Institute of New Jersey
| | - Carolyn Heckman
- Cancer Prevention and Control Program, Fox Chase Cancer Center
| | - Frank Penedo
- Department of Medical Social Sciences, Northwestern University School of Medicine
| | | | - Shannon Myers Virtue
- Department of Pediatric Dentistry and Community Oral Health Sciences, Temple University School of Dentistry
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12
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Hoyt MA, Gaffey AE, Wang AW, Litwin MS, Lawsin CJ. Sexual well-being and diurnal cortisol after prostate cancer treatment. J Health Psychol 2018; 25:1796-1801. [PMID: 29696999 DOI: 10.1177/1359105318772655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sexual dysfunction and psychological distress are common after prostate cancer. Research has not examined the role of neuroendocrine markers of stress (e.g. cortisol). This study examines whether sexual functioning or sexual bother is associated with diurnal cortisol. Men treated for prostate cancer completed the University of California-Los Angeles Prostate Cancer Index and provided saliva samples four times daily for cortisol assessment. Higher sexual bother, but not sexual functioning, was associated with steeper cortisol slope. Better sexual functioning, and not sexual bother, was significantly associated with the cortisol awakening response. Assessment of stress and stress-reducing interventions might be warranted in sexual rehabilitation after prostate cancer.
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13
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Gacci M, Noale M, Artibani W, Bassi PF, Bertoni F, Bracarda S, Conti GN, Corvò R, Graziotti P, Magrini SM, Mirone V, Montironi R, Muto G, Pecoraro S, Porreca A, Ricardi U, Russi E, Tubaro A, Zagonel V, Crepaldi G, Maggi S. Quality of Life After Prostate Cancer Diagnosis: Data from the Pros-IT CNR. Eur Urol Focus 2017; 3:321-324. [PMID: 29146557 DOI: 10.1016/j.euf.2017.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/20/2017] [Indexed: 11/28/2022]
Abstract
Pros-IT CNR study provides a real-life report on changes in quality of life 6 mo after the diagnosis of prostate cancer.
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Affiliation(s)
- Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, AOUC, University of Florence, Florence, Italy.
| | - Marianna Noale
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
| | - Walter Artibani
- Urologic Clinic, Department of Oncological and Surgical Sciences, Azienda Ospedaliera Universitaria Integrata and University of Verona, Verona, Italy
| | | | - Filippo Bertoni
- Prostate Group of AIRO - Italian Association for Radiation Oncology, Rome, Italy
| | | | | | - Renzo Corvò
- Department of Radiation Oncology, IRCCS San Martino-IST National Cancer Research Institute and University, Genoa, Italy
| | | | | | - Vincenzo Mirone
- Department of Urology, Federico II University, Naples, Italy
| | - Rodolfo Montironi
- Pathological Anatomy, Polytechnic University of the Marche Region, Ancona, Italy
| | - Giovanni Muto
- Department of Urology, Campus Bio-medico University, Rome, Italy
| | | | - Angelo Porreca
- Department of Urology, Abano Terme General Hospital, Padua, Italy
| | | | - Elvio Russi
- Radiation Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | | | - Vittorina Zagonel
- Medical Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Gaetano Crepaldi
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
| | - Stefania Maggi
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
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Abstract
Sexual dysfunction is a common concern for many patients with cancer after treatment. Hormonal changes as a result of cancer-directed therapy can affect both male and female sexual health. This has the potential to significantly impact patients' quality of life, but is underreported and undertreated in the oncology setting. This review discusses commonly reported sexual issues and the role that hormonal changes play in this dysfunction. Although medical and psychosocial intervention strategies exist, there is a clear need for further research to formally develop programming that can assist people whose sexual health has been impacted by cancer treatment.
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Affiliation(s)
- Eric S Zhou
- Pediatric Oncology, Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Natasha N Frederick
- Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Pediatric Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Sharon L Bober
- Pediatric Oncology, Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Sexual Health Program, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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15
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Noale M, Maggi S, Artibani W, Bassi PF, Bertoni F, Bracarda S, Conti GN, Corvò R, Gacci M, Graziotti P, Magrini SM, Maurizi Enrici R, Mirone V, Montironi R, Muto G, Pecoraro S, Porreca A, Ricardi U, Tubaro A, Zagonel V, Zattoni F, Crepaldi G. Pros-IT CNR: an Italian prostate cancer monitoring project. Aging Clin Exp Res 2017; 29:165-172. [PMID: 28236267 DOI: 10.1007/s40520-017-0735-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 11/28/2022]
Abstract
AIMS The Pros-IT CNR project aims to monitor a sample of Italian males ≥18 years of age who have been diagnosed in the participating centers with incident prostate cancer, by analyzing their clinical features, treatment protocols and outcome results in relation to quality of life. METHODS Pros-IT CNR is an observational, prospective, multicenter study. The National Research Council (CNR), Neuroscience Institute, Aging Branch (Padua) is the promoting center. Ninety-seven Italian centers located throughout Italy were involved. The field study began in September 1, 2014. Subjects eligible were diagnosed with biopsy-verified prostate cancer, naïve. A sample size of 1500 patients was contemplated. A baseline assessment including anamnestic data, clinical history, risk factors, the initial diagnosis, cancer staging information and quality of life (Italian UCLA Prostate Cancer Index; SF-12 Scale) was completed. Six months after the initial diagnosis, a second assessment evaluating the patient's health status, the treatment carried out, and the quality of life will be made. A third assessment, evaluating the treatment follow-up and the quality of life, will be made 12 months after the initial diagnosis. The 4th, 5th, 6th and 7th assessments, similar to the third, will be completed 24, 36, 48 and 60 months after the initial diagnosis, respectively, and will include also a Food Frequency Questionnaire and the Physical Activity Scale for the Elderly. DISCUSSION The study will provide information on patients' quality of life and its variations over time in relation to the treatments received for the prostate cancer.
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Affiliation(s)
- Marianna Noale
- CNR, Aging Branch, Neuroscience Institute, Via Giustiniani 2, 35128, Padova, Italy.
| | - Stefania Maggi
- CNR, Aging Branch, Neuroscience Institute, Via Giustiniani 2, 35128, Padova, Italy
| | - Walter Artibani
- Azienda Ospedaliera Universitaria integrata di Verona, Verona, Italy
| | - Pier Francesco Bassi
- Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore di Milano-sede di Roma, Milan, Italy
| | - Filippo Bertoni
- Prostate Group of AIRO-Italian Association for Radiation Oncology, Brescia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gaetano Crepaldi
- CNR, Aging Branch, Neuroscience Institute, Via Giustiniani 2, 35128, Padova, Italy
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16
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Gacci M, Sebastianelli A, Salvi M, De Nunzio C, Tubaro A, Gravas S, Moncada I, Serni S, Maggi M, Vignozzi L. The Impact of Central Obesity on Storage Luts and Urinary Incontinence After Prostatic Surgery. Curr Urol Rep 2016; 17:61. [PMID: 27432378 DOI: 10.1007/s11934-016-0620-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the developed and developing countries, the overall prevalence of central obesity in the elderly men is growing. In addition, the progressive aging of male population increased the possibilities of coexisting morbidities associated with obesity such as lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) or to prostate cancer (PCa) needing primary treatment, including radical prostatectomy (RP), which can further adversely affect the quality of life. Simple and radical prostatectomy are the most common surgical procedures in urologic unit all over the world for BPE and PCa, respectively. After both interventions, patients can present bothering storage LUTS that can worsen all the other clinical outcomes. Preset study will review the role of central obesity as a risk factor for storage LUTS or urinary incontinence, after prostatic surgery for BPE or PCa.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, Careggi Hospital, University of Florence, Viale A. Gramsci 7, 50121, Florence, Italy.
| | - Arcangelo Sebastianelli
- Department of Urology, Careggi Hospital, University of Florence, Viale A. Gramsci 7, 50121, Florence, Italy
| | - Matteo Salvi
- Department of Urology, Careggi Hospital, University of Florence, Viale A. Gramsci 7, 50121, Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University 'La Sapienza', Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University 'La Sapienza', Rome, Italy
| | - Stavros Gravas
- Department of Urology, University Hospital of Larissa, Larissa, Greece
| | | | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Viale A. Gramsci 7, 50121, Florence, Italy
| | - Mario Maggi
- Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Linda Vignozzi
- Department of Clinical Physiopathology, University of Florence, Florence, Italy
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17
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Hormonal changes after localized prostate cancer treatment. Comparison between external beam radiation therapy and radical prostatectomy. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.acuroe.2016.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Hormonal changes after localized prostate cancer treatment. Comparison between external beam radiation therapy and radical prostatectomy. Actas Urol Esp 2016; 40:549-555. [PMID: 27207596 DOI: 10.1016/j.acuro.2016.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the influence of radical prostatectomy (RP) and external beam radiation therapy (EBRT) on the hypothalamic pituitary axis of 120 men with clinically localized prostate cancer treated with RP or EBRT exclusively. MATERIALS AND METHODS 120 patients with localized prostate cancer were enrolled. Ninety two patients underwent RP and 28 patients EBRT exclusively. We measured serum levels of luteinizing hormone, follicle stimulating hormone (FSH), total testosterone (T), free testosterone, and estradiol at baseline and at 3 and 12 months after treatment completion. RESULTS Patients undergoing RP were younger and presented a higher prostate volume (64.3 vs. 71.1 years, p<0.0001 and 55.1 vs. 36.5 g, p<0.0001; respectively). No differences regarding serum hormonal levels were found at baseline. Luteinizing hormone and FSH levels were significantly higher in those patients treated with EBRT at three months (luteinizing hormone 8,54 vs. 4,76 U/l, FSH 22,96 vs. 8,18 U/l, p<0,0001) while T and free testosterone levels were significantly lower (T 360,3 vs. 414,83ng/dl, p 0,039; free testosterone 5,94 vs. 7,5pg/ml, p 0,018). At 12 months FSH levels remained significantly higher in patients treated with EBRT compared to patients treated with RP (21,01 vs. 8,51 U/l, p<0,001) while T levels remained significantly lower (339,89 vs. 402,39ng/dl, p 0,03). CONCLUSIONS Prostate cancer treatment influences the hypothalamic pituitary axis. This influence seems to be more important when patients with prostate cancer are treated with EBRT rather than RP. More studies are needed to elucidate the role that prostate may play as an endocrine organ.
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19
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Canalichio K, Jaber Y, Wang R. Surgery and hormonal treatment for prostate cancer and sexual function. Transl Androl Urol 2016; 4:103-9. [PMID: 26816817 PMCID: PMC4708130 DOI: 10.3978/j.issn.2223-4683.2015.01.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Prostate cancer (PC) is one of the most common cancers effecting men today. With earlier detection and improvements in available treatment modalities, there still remains significant morbidity associated with the treatment of PC. Male sexual health and erectile function are greatly impacted by these therapies and remain a concern to PC survivors. This article reviews the current literature on male sexual health following radical prostatectomy (RP) or androgen ablation therapy for PC. Each treatment modality affects male sexual function to an appreciable level, although certain patients have better outcomes if they have preoperative potency, are younger, or have nerve-sparing surgery. There is a delayed recovery up to 2 years seen in erectile function following RP. With androgen deprivation therapy (ADT), attempts can be made at different administration strategies and exercise may possibly play a role in maintaining erectile function. Penile rehabilitation protocols attempt to protect erectile function immediately following therapy through different modalities, although no one approach has been agreed upon.
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Affiliation(s)
- Katie Canalichio
- 1 Division of Urology, University of Texas Health Science Center, Houston, TX 77030, USA ; 2 Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yasmeen Jaber
- 1 Division of Urology, University of Texas Health Science Center, Houston, TX 77030, USA ; 2 Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Run Wang
- 1 Division of Urology, University of Texas Health Science Center, Houston, TX 77030, USA ; 2 Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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20
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Zhou ES, Nekhlyudov L, Bober SL. The primary health care physician and the cancer patient: tips and strategies for managing sexual health. Transl Androl Urol 2016; 4:218-31. [PMID: 26816826 PMCID: PMC4708119 DOI: 10.3978/j.issn.2223-4683.2014.11.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in order are also described in order to emphasize the importance of PCPs initiating this important conversation. Next, we provide strategies and resources to help guide the PCP in the management of sexual dysfunction in cancer survivors. Finally, we discuss case examples of survivorship sexual health issues and highlight the role that a PCP can play in each of these case examples.
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Affiliation(s)
- Eric S Zhou
- 1 Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA ; 2 Harvard Vanguard Medical Associates, Boston, Massachusetts, USA
| | - Larissa Nekhlyudov
- 1 Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA ; 2 Harvard Vanguard Medical Associates, Boston, Massachusetts, USA
| | - Sharon L Bober
- 1 Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA ; 2 Harvard Vanguard Medical Associates, Boston, Massachusetts, USA
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21
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Manne SL, Kissane D, Zaider T, Kashy D, Lee D, Heckman C, Virtue SM. Holding back, intimacy, and psychological and relationship outcomes among couples coping with prostate cancer. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2015; 29:708-19. [PMID: 26192132 PMCID: PMC5225663 DOI: 10.1037/fam0000096] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The present study evaluated intimacy as a mechanism for the effects of holding back sharing concerns about cancer on couples' psychological distress, well-being, and marital satisfaction using the actor-partner interdependence model (APIM), and evaluated 2 possible moderators of these associations: the number of patient and spouse cancer concerns. We had 139 men treated for localized prostate cancer in the past year and their spouses complete surveys about holding back sharing cancer concerns, intimacy, distress, and relationship satisfaction, as well as patient and spouse cancer concerns. APIM-indicated that the association between holding back sharing concerns, and patient and spouse distress, well-being, and relationship satisfaction could be partially accounted for by their influence on patient and spouse perceptions of relationship intimacy. The number of cancer concerns did not moderate the mediational model. Holding back has strong associations with both partners' well-being and distress. Holding back sharing concerns was particularly detrimental for couples' intimacy and relationship satisfaction.
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Affiliation(s)
- Sharon L Manne
- Section of Population Science, Rutgers Cancer Institute of New Jersey
| | - David Kissane
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Talia Zaider
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | | | - David Lee
- Department of Surgery, University of Pennsylvania School of Medicine
| | - Carolyn Heckman
- Cancer Prevention and Control Program, Fox Chase Cancer Center
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22
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Alenizi AM, Bienz M, Rajih E, Alesawi A, Al-Hathal N, Benayoun S, Lebeau T, Zorn KC, El-Hakim A. Uroflow Stop Test and Potency Recovery: A Surrogate for Pelvic Floor Integrity Post Robotic-Assisted Radical Prostatectomy? Urology 2015; 86:766-71. [PMID: 26254170 DOI: 10.1016/j.urology.2015.05.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/22/2015] [Accepted: 05/08/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the relation between uroflow Stop Test and early recovery of potency following robot-assisted radical prostatectomy (RARP). We recently showed that the ability to completely stop urine flow during voiding, measured objectively by uroflowmetry at the time of catheter removal (uroflow Stop Test) can predict early urinary continence recovery following RARP. MATERIALS AND METHODS In this prospective observational cohort, data were collected on 108 patients operated by a single surgeon (AEH). Eighty patients had a positive uroflow Stop Test (group one) and 28 had a negative Stop Test (group two). Patients were followed for a minimum of 2 years. Covariates included age, body mass index, international prostate symptom score and sexual health inventory for men scores, prostate-specific antigen, tumor stage, prostate volume, nerve sparing status, and estimated blood loss. RESULTS Preoperative characteristics were comparable between both groups except nerve sparing and prostate-specific antigen which were statistically higher in group one (P <.05). Early 3- and 6-months recovery of erectile function was significantly higher in group one. Potency rates in group one and two at 1, 3, 6, 9, 12, 18, and 24 months were 25% vs 14.3% (P = .241), 54.5% vs 18.5% (P = .001), 55.4% vs 18.5% (P = .001), 56.4% vs 36% (P = .084), 66.6% vs 50% (P = .141), 65.5% vs 56% (P = .404) and 73.2% vs 57.7% (P = .160) respectively. Uroflow Stop Test was independent predictor of early potency recovery on multivariate regression analysis at 6 months [odds ratio 6.042 (confidence interval 95% 1.496-24.413) P = .012]. CONCLUSION Uroflow Stop Test is simple and can help predict early potency recovery following RARP.
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Affiliation(s)
- Abdullah M Alenizi
- Division of Robotic Urology, Department of Surgery, Hôpital Sacré Cœur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Bienz
- Division of Robotic Urology, Department of Surgery, Hôpital Sacré Cœur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Emad Rajih
- Division of Robotic Urology, Department of Surgery, Hôpital Sacré Cœur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Anwar Alesawi
- Division of Robotic Urology, Department of Surgery, Hôpital Sacré Cœur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Naif Al-Hathal
- Division of Robotic Urology, Department of Surgery, Hôpital Sacré Cœur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Serge Benayoun
- Division of Robotic Urology, Department of Surgery, Hôpital Sacré Cœur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Thierry Lebeau
- Division of Robotic Urology, Department of Surgery, Hôpital Sacré Cœur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Kevin C Zorn
- Division of Robotic Urology, Department of Surgery, Hôpital Sacré Cœur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Assaad El-Hakim
- Division of Robotic Urology, Department of Surgery, Hôpital Sacré Cœur de Montréal, Université de Montréal, Montreal, Quebec, Canada.
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23
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Hudson SV, O'Malley DM, Miller SM. Achieving optimal delivery of follow-up care for prostate cancer survivors: improving patient outcomes. PATIENT-RELATED OUTCOME MEASURES 2015; 6:75-90. [PMID: 25834471 PMCID: PMC4372007 DOI: 10.2147/prom.s49588] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Prostate cancer is the most commonly diagnosed cancer in men in the US, and the second most prevalent cancer in men worldwide. High incidence and survival rates for prostate cancer have resulted in a large and growing population of long-term prostate cancer survivors. Long-term follow-up guidelines have only recently been developed to inform approaches to this phase of care for the prostate cancer population. Methods A PubMed search of English literature through August 2014 was performed. Articles were retrieved and reviewed to confirm their relevance. Patient-reported measures that were used in studies of long-term prostate cancer survivors (ie, at least 2 years posttreatment) were reviewed and included in the review. Results A total of 343 abstracts were initially identified from the database search. After abstract review, 105 full-text articles were reviewed of which seven met inclusion criteria. An additional 22 articles were identified from the references of the included articles, and 29 were retained. From the 29 articles, 68 patient-reported outcome measures were identified. The majority (75%) were multi-item scales that had been previously validated in existing literature. We identified four main areas of assessment: 1) physical health; 2) quality of life – general, physical, and psychosocial; 3) health promotion – physical activity, diet, and tobacco cessation; and 4) care quality outcomes. Conclusion There are a number of well-validated measures that assess patient-reported outcomes that document key aspects of long-term follow-up with respect to patient symptoms and quality of life. However, there are fewer patient-reported outcomes related to health promotion and care quality within the prevention, surveillance, and care coordination components of cancer survivorship. Future research should focus on development of additional patient-centered and patient-related outcomes that enlarge the assessment portfolio.
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Affiliation(s)
- Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Somerset
| | | | - Suzanne M Miller
- Cancer Prevention and Control Program, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
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24
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[Sexuality of couples 5 years after radical prostatectomy. Sexuality of patients and their partners 1 year postoperatively in sexually active couples]. Urologe A 2015; 54:1407-13. [PMID: 25680472 DOI: 10.1007/s00120-014-3755-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Erectile dysfunction after radical prostatectomy (RPx) does affect the sexual life of patients and their partners. In our study, we evaluated sexual life over the long-term of 60 months following nerve-sparing (ns) RPx in couples who successfully performed sexual intercourse (SI) 12 months after surgery. PATIENTS AND METHOD A total of 36 patients and their female partners who had SI prior to and 12 months after nsRPx were included in this study. Sixty months following nsRPx, couples were asked about frequency of SI, satisfaction of sexual life, usage of medical aid for erections, and sexual function [patients: IIEF-5 (International Index of Erectile Function), partners: FSFI (Female Sexual Function Index)]. RESULTS Thirty couples (83.3%) were available for follow-up. A total of 70% of couples performed SI 60 months after nsRPx. In contrast to couples who did not have SI 60 months after nsRPx, couples who successfully had SI were more satisfied, had SI more often, had higher IIEF-5 scores, and higher frequency of bilateral ns surgery. In 80% of those patients, no medical aid except PDE-5 inhibitors were used. The partners of those patients were more satisfied with their sexual life, compared to the patients themselves. Couples, in whom the patient had IIEF-5 scores ≥19 were more satisfied, had SI more often, and the partners had higher FSFI scores, compared to couples with patients' IIEF-5 scores <19. CONCLUSION Couples who had successfully performed SI within 12 months following nsRPx continue to have satisfying SI in the long-term. Those couples are more satisfied with their sexual life and have SI more often prior to and 12 months after nsRPx.
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Benedict C, Traeger L, Dahn JR, Antoni M, Zhou ES, Bustillo N, Penedo FJ. Sexual bother in men with advanced prostate cancer undergoing androgen deprivation therapy. J Sex Med 2014; 11:2571-80. [PMID: 25059094 PMCID: PMC11302979 DOI: 10.1111/jsm.12645] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Men with advanced prostate cancer (APC) undergoing androgen deprivation therapy (ADT) often experience distressing sexual side effects. Sexual bother is an important component of adjustment. Factors associated with increased bother are not well understood. AIMS This study sought to describe sexual dysfunction and bother in APC patients undergoing ADT, identify socio-demographic and health/disease-related characteristics related to sexual bother, and evaluate associations between sexual bother and psychosocial well-being and quality of life (QOL). METHODS Baseline data of a larger psychosocial intervention study was used. Pearson's correlation and independent samples t-test tested bivariate relations. Multivariate regression analysis evaluated relations between sexual bother and psychosocial and QOL outcomes. MAIN OUTCOME MEASURES The Expanded Prostate Cancer Index Composite sexual function and bother subscales, Center for Epidemiologic Studies Depression Scale, Functional Assessment of Cancer Therapy--General, and Dyadic Adjustment Scale were the main outcome measures. RESULTS Participants (N = 80) were 70 years old (standard deviation [SD] = 9.6) and reported 18.7 months (SD = 17.3) of ADT. Sexual dysfunction (mean = 10.1; SD = 18.0) was highly prevalent. Greater sexual bother (lower scores) was related to younger age (β = 0.25, P = 0.03) and fewer months of ADT (β = 0.22, P = 0.05). Controlling for age, months of ADT, current and precancer sexual function, sexual bother correlated with more depressive symptoms (β = -0.24, P = 0.06) and lower QOL (β = 0.25, P = 0.05). Contrary to hypotheses, greater sexual bother was related to greater dyadic satisfaction (β = -0.35, P = 0.03) and cohesion (β = -0.42, P = 0.01). CONCLUSIONS The majority of APC patients undergoing ADT will experience sexual dysfunction, but there is variability in their degree of sexual bother. Psychosocial aspects of sexual functioning should be considered when evaluating men's adjustment to ADT effects. Assessment of sexual bother may help identify men at risk for more general distress and lowered QOL. Psychosocial interventions targeting sexual bother may complement medical treatments for sexual dysfunction and be clinically relevant, particularly for younger men and those first starting ADT.
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Affiliation(s)
- Catherine Benedict
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jason R. Dahn
- Mental Health and Behavioral Science, Miami Veteran Affairs Healthcare System, Miami, FL, USA
| | - Michael Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Eric S. Zhou
- Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Natalie Bustillo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Frank J. Penedo
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Gacci M. Editorial comment. J Urol 2014; 192:1161. [PMID: 25014525 DOI: 10.1016/j.juro.2014.03.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mauro Gacci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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Gacci M, Baldi E, Tamburrino L, Detti B, Livi L, De Nunzio C, Tubaro A, Gravas S, Carini M, Serni S. Quality of Life and Sexual Health in the Aging of PCa Survivors. Int J Endocrinol 2014; 2014:470592. [PMID: 24744780 PMCID: PMC3976934 DOI: 10.1155/2014/470592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 02/02/2014] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer (PCa) is the most common malignancy in elderly men. The progressive ageing of the world male population will further increase the need for tailored assessment and treatment of PCa patients. The determinant role of androgens and sexual hormones for PCa growth and progression has been established. However, several trials on androgens and PCa are recently focused on urinary continence, quality of life, and sexual function, suggesting a new point of view on the whole endocrinological aspect of PCa. During aging, metabolic syndrome, including diabetes, hypertension, dyslipidemia, and central obesity, can be associated with a chronic, low-grade inflammation of the prostate and with changes in the sex steroid pathways. These factors may affect both the carcinogenesis processes and treatment outcomes of PCa. Any treatment for PCa can have a long-lasting negative impact on quality of life and sexual health, which should be assessed by validated self-reported questionnaires. In particular, sexual health, urinary continence, and bowel function can be worsened after prostatectomy, radiotherapy, or hormone treatment, mostly in the elderly population. In the present review we summarized the current knowledge on the role of hormones, metabolic features, and primary treatments for PCa on the quality of life and sexual health of elderly Pca survivors.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
| | - Elisabetta Baldi
- Department of Experimental and Clinical Biomedical Sciences, Section of Clinical Pathophysiology, University of Florence, Italy
| | - Lara Tamburrino
- Department of Experimental and Clinical Biomedical Sciences, Section of Clinical Pathophysiology, University of Florence, Italy
| | - Beatrice Detti
- Radiotherapy, University Hospital Careggi, University of Florence, Italy
| | - Lorenzo Livi
- Radiotherapy, University Hospital Careggi, University of Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University “La Sapienza”, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University “La Sapienza”, Rome, Italy
| | - Stavros Gravas
- Department of Urology, University Hospital of Larissa, Larissa, Greece
| | - Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
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Abstract
BACKGROUND Minimally invasive laparoscopic radical prostatectomy (LRP) has proven equally effective as open surgery in terms of cancer control and peroperative complication rate with less bleeding and postoperative pain. However, long-term follow-up data after LRP are scarce, especially as related to quality of life (QoL). AIM To compare QoL and functional outcomes at least 10 years after LRP with a population-based control group matched for age and region. METHODS Follow-up data were obtained by mailed questionnaires from patients who responded anonymously to five international questionnaires (EQ-5D, QLQ-C30, QLQ-PR25, IPSS, and IIEF). We collected self-reported outcome data directly from 49 patients who underwent LRP more than 10 years ago in our centre. The results of the patients' overall QoL and urinary continence rates were compared with 918 controls matched for region and age. RESULTS Forty-two patients (86%) and 808 (88%) controls reported having no urinary leakage. Only 11 patients (24%) still had sexual activities 10 years after LRP, and three were without erectile dysfunction. There was no difference in four of five statements of the self-assessed QoL questionnaires between the LRP and control group. Anxiety level was higher in the LRP group (44%) than in the control group (23%). CONCLUSION Patients reported high self-assessed QoL, although they also reported low sexual activity 10 years after LRP. Prevalence of urinary leakage was similar in both groups. However, anxiety was more common in LRP patients.
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Affiliation(s)
- Eugen Y-H Wang
- Centre for Clinical Research, Sörmland, Uppsala University , Eskilstuna , Sweden
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Mauro G. Editorial comment to preservation of the internal sphincter and of the proximal urethra during retropubic radical prostatectomy: a safe option for well-selected cases. Int J Urol 2013; 21:526. [PMID: 24256428 DOI: 10.1111/iju.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gacci Mauro
- Department of Urology, University of Florence, Florence, Italy.
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30
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Shinohara N, Maruyama S, Shimizu S, Nishioka K, Abe T, C-Hatanaka K, Oba K, Nonomura K, Shirato H. Longitudinal comparison of quality of life after real-time tumor-tracking intensity-modulated radiation therapy and radical prostatectomy in patients with localized prostate cancer. JOURNAL OF RADIATION RESEARCH 2013; 54:1095-101. [PMID: 23660274 PMCID: PMC3823776 DOI: 10.1093/jrr/rrt049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/26/2013] [Accepted: 03/28/2013] [Indexed: 05/24/2023]
Abstract
The purpose of this study was to compare the quality of life (QOL) in patients with localized prostate cancer (PC) after intensity-modulated radiation therapy assisted with a fluoroscopic real-time intensity-modulated radiation therapy (RT-IMRT) tumor-tracking system versus the QOL after radical prostatectomy (RP). Between 2003 and 2006, 71 patients were enrolled in this longitudinal prospective study. Each patient was allowed to decide which treatment modality they would receive. Of the 71 patients, 23 patients underwent RT-IMRT, while 48 opted for RP. No patient received neo-adjuvant or adjuvant hormone therapy. The global QOL and disease-specific-QOL were evaluated before treatment and again at 1, 3 and 5 years after treatment. There was no significant difference in the background characteristics between the two groups. The 5-year biochemical progression-free survival was 90% in the RT-IMRT and 79% in the RP group. In the RT-IMRT group, there was no significant deterioration of the global QOL or disease-specific QOL through 5 years post-treatment. In the RP group, the urinary function, sexual function, and sexual bother indicators significantly deteriorated after treatment. Urinary and sexual function was significantly better in the RT-IMRT group at 1, 3 and 5 years post-treatment compared to the RP group. RT-IMRT may be a preferable treatment for localized PC because of similar efficacy to RP but better post-treatment QOL.
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Affiliation(s)
- Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kitaku, Sapporo 060-8638, Japan
| | - Satoru Maruyama
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kitaku, Sapporo 060-8638, Japan
| | - Shinichi Shimizu
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Nishioka
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kitaku, Sapporo 060-8638, Japan
| | - Kanako C-Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Koji Oba
- Translational Research and Clinical Trial Center, Hokkaido University Hospital, North-14, West-5, Kitaku, Sapporo 060-8638, Japan
| | - Katsuya Nonomura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kitaku, Sapporo 060-8638, Japan
| | - Hiroki Shirato
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Ellison JS, He C, Wood DP. Early Postoperative Urinary and Sexual Function Predicts Functional Recovery 1 Year after Prostatectomy. J Urol 2013; 190:1233-8. [DOI: 10.1016/j.juro.2013.04.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Affiliation(s)
| | - Chang He
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - David P. Wood
- Department of Urology, University of Michigan, Ann Arbor, Michigan
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33
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Factors related to patient-perceived satisfaction after robot-assisted radical prostatectomy based on the expanded prostate cancer index composite survey. Prostate Cancer Prostatic Dis 2013; 16:341-5. [PMID: 23917307 DOI: 10.1038/pcan.2013.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 06/14/2013] [Accepted: 06/20/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Few studies have analyzed factors that influence longitudinal changes in patient-perceived satisfaction during the recovery period following robot-assisted radical prostatectomy (RARP) for prostate cancer. We investigated variables that were associated with patient-perceived satisfaction after RARP using the expanded prostate cancer index composite (EPIC) survey. METHODS Of 175 men who underwent RARP between 2010 and 2011, 140 men completed the EPIC questionnaire preoperatively and 3, 6 and 12 months postoperatively. On the basis of the EPIC question no. 32 (item number 80), patients were divided into four groups according to the pattern of satisfaction change at postoperative 3 and 12 months: satisfied to satisfied (group 1); satisfied to dissatisfied (group 2); dissatisfied to satisfied (group 3); and dissatisfied to dissatisfied (group 4). Longitudinal changes in EPIC scores over time in each group and differences in EPIC scores of each domain subscale between groups at each follow-up were analyzed. A linear mixed model with generalized estimating equation approach was used to identify independent factors that influence overall satisfaction among repeated measures from same patients. RESULTS On the basis of the pattern of satisfaction change, groups 1, 2, 3 and 4 had 103 (74.3%), 21 (15.0%), 11 (7.9%) and 5 (2.9%) patients, respectively. The factor that was associated with overall satisfaction was urinary bother (UB) (β=0.283, 95% confidence interval (0.024, 0.543 ); P=0.033) adjusted for other factors under consideration. CONCLUSIONS UB was the independent factor influencing patient-perceived satisfaction after RARP. During post-RARP follow-up, physician should have the optimal management for the patient's UB.
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Gacci M, Tosi N, Vittori G, Minervini A, Corona G, Cai T, Morelli AM, Vignozzi L, Serni S, Maggi M, Carini M. Changes in sex hormone levels after radical prostatectomy: Results of a longitudinal cohort study. Oncol Lett 2013; 6:529-533. [PMID: 24137361 PMCID: PMC3789060 DOI: 10.3892/ol.2013.1420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/28/2013] [Indexed: 11/16/2022] Open
Abstract
The changes in testosterone and gonadotropin levels in patients who have undergone radical prostatectomy (RP) for clinically localized prostate cancer (PCa) remain unclear. The aim of the present study was to prospectively evaluate the changes in serum testosterone (Te), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the early months after RP for PCa and the correlation between these hormones at various follow-up times. A total of 100 male patients with clinically localized PCa were consecutively included in the study. The serum levels of Te, LH and FSH were measured prior to RP (baseline) and at 1 and 3 months post-operatively. Changes in the levels of Te, LH and FSH between the baseline and at 1 and 3 months after RP were analyzed with paired sample t-tests. The correlations between LH and Te levels at the various follow-up times were evaluated with a Spearman’s rank correlation coefficient. At 1 month subsequent to RP, the Te levels were significantly decreased (baseline vs. 1 month, P=0.021) and subsequently recovered to the pre-operative value at 3 months (baseline vs. 3 months, P=0.372). The mean Te level at baseline was 15.3 nmol/l, while at 1 and 3 months it was 13.8 and 14.4 nmol/l, respectively. By contrast, the levels of LH and FSH were significantly increased at 1 and 3 months post-surgery, compared with the baseline value (baseline vs. 1 or 3 months, P<0.0001). The pre-operative correlation between LH and Te was lost 1 month after RP and recovered after 3 months. Notably, the LH level at 1 month was markedly correlated with the Te levels recorded after 3 months. In the present study, patients developed compensated hypergonadotropic hypogonadism 3 months after RP.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Florence, Italy
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35
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Gacci M, Sebastianelli A, Salvi M, De nunzio C, Schiavina R, Simonato A, Tubaro A, Mirone V, Carini M, Carmignani G. Role of abdominal obesity for functional outcomes and complications in men treated with radical prostatectomy for prostate cancer: results of the Multicenter Italian Report on Radical Prostatectomy (MIRROR) study. Scand J Urol 2013; 48:138-45. [DOI: 10.3109/21681805.2013.803151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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36
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Jakobsson L, Persson L, Lundqvist P. Daily life and life quality 3 years following prostate cancer treatment. BMC Nurs 2013; 12:11. [PMID: 23574878 PMCID: PMC3626890 DOI: 10.1186/1472-6955-12-11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/04/2013] [Indexed: 11/22/2022] Open
Abstract
Background Knowledge of experiences from prostate cancer is sparse in a longitudinal perspective. From a nursing perspective, results from combined qualitative and quantitative studies are lacking however would present the broadest knowledge base for best practice. Present descriptions of medical-physical symptoms such as urinary, bowel and sexual dysfunction from quantitative inquiries need be complemented with qualitative results. Such knowledge is essential in relation to treatment and communication with patients over the years and not only shortly after surgery. Methods A longitudinal study was formatted to investigate general and specific health quality and sense of coherence quantitative alterations over three years. A general health quality module (EORTC QLC-C30) and a disease-specific module (EORTC PR-25) were applied for the longitudinal study together with the Orientation to life questionnaire (SOC), measuring a persons’ sense of coherence. In order to strengthen reliability and compensate for low participation we used the Directed content analysis for interviewing and analysis. The method allows using findings from earlier research when interviewing along with detecting new areas. Twenty-one men were followed over three years and six of them, in the third year, accepted to be interviewed. Results We found high quality of life ratings and extended the study with follow-up interviews in year three, to investigate whether questionnaire results were in line with interview findings. We found high life quality and functioning ratings that were in line with qualitative descriptions. Interview analysis showed retrieval of life as lived before, yet in a different way, the men never forgot the diagnosis event, had a unique illness history worth hearing, and had come to terms with most treatment-related shortcomings. Sense of coherence ratings were medium to high and confirmed stability over time in comprehensibility, manageability and meaningfulness after prostate cancer treatment. Conclusions Over the years, the men’s negative experiences from shifted into ‘a good life’ though in a different way than before. The interpretation is supported in the study by quantitative results showing a high degree of functioning. The men’s sense of coherence seamed to support their handling of life three years after prostate cancer treatment.
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Affiliation(s)
- Liselotte Jakobsson
- School of Health and Society, Kristianstad University, 291 88 Kristianstad, Sweden
| | - Lena Persson
- School of Health and Society, Kristianstad University, 291 88 Kristianstad, Sweden
| | - Pia Lundqvist
- Division of Nursing, Department of Health Sciences, Lund University, Lund, Sweden
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Vanagas G, Mickeviciene A, Ulys A. Does quality of life of prostate cancer patients differ by stage and treatment? Scand J Public Health 2012; 41:58-64. [PMID: 23221377 DOI: 10.1177/1403494812467503] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The lack of consensus amongst experts delineate how important it is for patients diagnosed with prostate cancer (PCa) to make an informed decision on available treatment options through an objective discussion of the risks and benefits. One of important benefits could be seen as patient's quality of life (QoL) after treatment. We aimed to assess QoL differences in prostate cancer patients by stage and treatment for a population-based sample. METHODS The cross-sectional PCa patient population-based national level study for a prostate cancer patient population was performed. QoL was investigated with EORTC QLQ-C30. The analysis includes descriptive statistics and evaluation of differences in functional and symptom scales by stage and treatment group by predictors in the model. RESULTS Response rate was 79.1% (N=514). The highest QoL scores were observed in localised PCa, active surveillance treatment group. The lowest scores were observed in advanced stages, chemotherapy treatment group. Between cancer stages, statistically significant differences were observed only in scales of emotional functioning (p<0.001) and social functioning (p<0.001). Between treatment groups, statistically significant differences were observed in scales of physical functioning (p<0.001), role functioning (p<0.001), emotional functioning (p<0.001), and social functioning (p<0.001). CONCLUSIONS Our study highlighted statistically significant differences in QoL between cancer stages and treatment. Understanding how the QoL changes in relation with the selected treatment option can be important to the urologist and individual patient to have realistic expectations as well as to optimise treatment decisions for the prostate cancer patient when exist several alternatives.
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Zaider T, Manne S, Nelson C, Mulhall J, Kissane D. Loss of masculine identity, marital affection, and sexual bother in men with localized prostate cancer. J Sex Med 2012; 9:2724-32. [PMID: 22989267 PMCID: PMC5180593 DOI: 10.1111/j.1743-6109.2012.02897.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is one of the most frequent sources of distress after treatment for prostate cancer (PCa), yet evidence suggests that men do not easily adjust to loss of sexual function over time. A hypothesized determinant of men's adaptation to ED is the degree to which they experience a loss of masculine identity in the aftermath of PCa treatment. AIMS The aims of this study were (i) to describe the prevalence of concerns related to diminished masculinity among men treated for localized PCa; (ii) to determine whether diminished masculinity is associated with sexual bother, after controlling for sexual functioning status; and (iii) to determine whether men's marital quality moderates the association between diminished masculinity and sexual bother. METHODS We analyzed cross-sectional data provided by 75 men with localized PCa who were treated at one of two cancer centers. Data for this study were provided at a baseline assessment as part of their enrollment in a pilot trial of a couple-based intervention. MAIN OUTCOME MEASURES The sexual bother subscale from the Prostate Health-Related Quality-of-Life Questionnaire and the Masculine Self-Esteem and Marital Affection subscales from Clark et al's PCa-related quality-of-life scale. RESULTS Approximately one-third of men felt they had lost a dimension of their masculinity following treatment. Diminished masculinity was the only significant, independent predictor of sexual bother, even after accounting for sexual functioning status. The association between diminished masculinity and sexual bother was strongest for men whose spouses perceived low marital affection. CONCLUSIONS Diminished masculinity is a prominent, yet understudied concern for PCa survivors. Regardless of functional status, men who perceive a loss of masculinity following treatment may be more likely to be distressed by their ED. Furthermore, its impact on adjustment in survivorship may rely on the quality of their intimate relationships.
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Affiliation(s)
- Talia Zaider
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Sharon Manne
- Section of Population Science, Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - John Mulhall
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - David Kissane
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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39
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Recovery of Urinary Function After Radical Prostatectomy: Identification of Trajectory Cluster Groups. J Urol 2012; 187:1346-51. [DOI: 10.1016/j.juro.2011.11.094] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Indexed: 11/18/2022]
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Song L, Northouse LL, Zhang L, Braun TM, Cimprich B, Ronis DL, Mood DW. Study of dyadic communication in couples managing prostate cancer: a longitudinal perspective. Psychooncology 2012; 21:72-81. [PMID: 20967920 PMCID: PMC3875561 DOI: 10.1002/pon.1861] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 08/15/2010] [Accepted: 08/28/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cancer patients and partners often report inadequate communication about illness-related issues, although it is essential for mutual support and informal caregiving. This study examined the patterns of change in dyadic communication between patients with prostate cancer and their partners, and also determined if certain factors affected their communication over time. METHOD Using multilevel modeling, this study analyzed longitudinal data obtained from a randomized clinical trial with prostate cancer patients and their partners, to examine their communication over time. Patients and partners (N=134 pairs) from the usual-care control group independently completed baseline demographic assessment and measures of social support, uncertainty, symptom distress, and dyadic communication at baseline, and 4-, 8-, and 12-month follow-ups. RESULTS The results indicated that (1) patients and partners reported similar levels of open communication at the time of diagnosis. Communication reported by patients and partners decreased over time in a similar trend, regardless of phase of illness; (2) phase of illness affected couples' open communication at diagnosis but not patterns of change over time; and (3) couples' perceived communication increased as they reported more social support, less uncertainty, and fewer hormonal symptoms in patients. Couples' demographic factors and general symptoms, and patients' prostate cancer-specific symptoms did not affect their levels of open communication. CONCLUSIONS Perceived open communication between prostate cancer patients and partners over time is affected by certain baseline and time-varying psychosocial and cancer-related factors. The results provide empirical evidence that may guide the development of strategies to facilitate couples' interaction and mutual support during survivorship.
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Affiliation(s)
- L Song
- University of North Carolina-Chapel Hill School of Nursing, Chapel Hill, NC 27599, USA.
| | - LL Northouse
- University of North Carolina-Chapel Hill School of Nursing, Chapel Hill, NC 27599, USA.
| | - L Zhang
- University of North Carolina-Chapel Hill School of Nursing, Chapel Hill, NC 27599, USA.
| | - TM Braun
- University of North Carolina-Chapel Hill School of Nursing, Chapel Hill, NC 27599, USA.
| | - B Cimprich
- University of North Carolina-Chapel Hill School of Nursing, Chapel Hill, NC 27599, USA.
| | - DL Ronis
- University of North Carolina-Chapel Hill School of Nursing, Chapel Hill, NC 27599, USA.
| | - DW Mood
- University of North Carolina-Chapel Hill School of Nursing, Chapel Hill, NC 27599, USA.
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Quon H, Cheung PCF, Loblaw DA, Morton G, Pang G, Szumacher E, Danjoux C, Choo R, Kiss A, Mamedov A, Deabreu A. Quality of life after hypofractionated concomitant intensity-modulated radiotherapy boost for high-risk prostate cancer. Int J Radiat Oncol Biol Phys 2011; 83:617-23. [PMID: 22079736 DOI: 10.1016/j.ijrobp.2011.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 06/29/2011] [Accepted: 07/06/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate the change in health-related quality of life (QOL) of patients with high-risk prostate cancer treated using hypofractionated radiotherapy combined with long-term androgen deprivation therapy. METHODS AND MATERIALS A prospective Phase I-II study enrolled patients with any of the following: clinical Stage T3 disease, prostate-specific antigen level ≥20 ng/mL, or Gleason score 8-10. Radiotherapy consisted of 45 Gy (1.8 Gy per fraction) to the pelvic lymph nodes with a concomitant 22.5 Gy intensity-modulated radiotherapy boost to the prostate, for a total of 67.5 Gy (2.7 Gy per fraction) in 25 fractions over 5 weeks. Daily image guidance was performed using three gold seed fiducials. Quality of life was measured using the Expanded Prostate Cancer Index Composite (EPIC), a validated tool that assesses four primary domains (urinary, bowel, sexual, and hormonal). RESULTS From 2004 to 2007, 97 patients were treated. Median follow-up was 39 months. Compared with baseline, at 24 months there was no statistically significant change in the mean urinary domain score (p = 0.99), whereas there were decreases in the bowel (p < 0.01), sexual (p < 0.01), and hormonal (p < 0.01) domains. The proportion of patients reporting a clinically significant difference in EPIC urinary, bowel, sexual, and hormonal scores at 24 months was 27%, 31%, 55%, and 60%, respectively. However, moderate and severe distress related to these symptoms was minimal, with increases of only 3% and 5% in the urinary and bowel domains, respectively. CONCLUSIONS Hypofractionated radiotherapy combined with long-term androgen deprivation therapy was well tolerated. Although there were modest rates of clinically significant patient-reported urinary and bowel toxicity, most of this caused only mild distress, and moderate and severe effects on QOL were limited. Additional follow-up is ongoing to characterize long-term QOL.
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Affiliation(s)
- Harvey Quon
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Bach P, Döring T, Gesenberg A, Möhring C, Goepel M. Quality of life of patients after retropubic prostatectomy - pre- and postoperative scores of the EORTC QLQ-C30 and QLQ-PR25. Health Qual Life Outcomes 2011; 9:93. [PMID: 22047686 PMCID: PMC3238231 DOI: 10.1186/1477-7525-9-93] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 11/02/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with newly diagnosed early stage prostate cancer (PCa) face a difficult choice of different treatment options with curative intention. They must consider both goals of optimising quantity and quality of life. The quality of life (QoL) is a psychometric outcome which is measured using validated questionnaires. Only few data are published concerning pre - and postoperative QoL. METHODS This study investigated pre perative QoL of 185 patients who consecutively underwent open radical retropubic prostatectomy for organ-confined PCa to postoperative QoL of another 185 patients. The EORTC QLQ-C30, EORTC QLQPR25 module and 24 h ICS pad test were used (mean follow-up 28.6 months). RESULTS The examined symptom scores of the EORTC QLQ-PR25 were on lowest level. In the dyspnoea symptom score differences of age emerged: the amount of patients who are short of breath rose significantly in older patients after surgery (p < 0.05 paired, two-tailed student's t-test).. Lastly, the urinary symptom score was found postal-therapeutically low; this fact was age independent. The results of sexual symptom score need to be taken into consideration, since prostatectomy resulted in a significant reduction of sexual activity independent of age. All functioning scales postoperatively reached high values without significant changes (p > 0.05 student's t-test ), which implies a high QoL after surgery. A reliable and satisfying status of continence was found in our patients after retropubic prostatectomy. A high rate of patients (89.2%) would choose retropubic prostatectomy again. CONCLUSION Retropubic prostatectomy represents a reliable and accepted procedure in the treatment of organ-confined PCa. For the first time it could be shown that patients` QoL remained on a high level after retropubic prostatectomy. Nevertheless, the primary avoidance or postoperative therapy of erectile dysfunction should be in the focus of surgeons.
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Affiliation(s)
- Peter Bach
- Department of Urology of Klinikum Niederberg Velbert, University of Duisburg-Essen, Germany.
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Punnen S, Cooperberg MR, Sadetsky N, Carroll PR. Among potent men post radical prostatectomy, does the need for phosphodiesterase inhibitors have an impact on sexual bother scores? BJU Int 2011; 109:1520-4. [PMID: 21999368 DOI: 10.1111/j.1464-410x.2011.10605.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Study Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Although phosphodiesterase inhibitor use post radical prostatectomy improves potency, little is known about its affects on sexual bother. We found no difference in sexual bother scores between patients who use and do not use phosphodiesterase inhibitors. This suggests that the current definition of potency, inclusive of medication use, is valid with respect to sexual bother. OBJECTIVE To determine whether the current definition of potency, inclusive of phosphodiesterase inhibitor (PDEi) use, is valid with respect to sexual bother (SB). This will be assessed by characterizing the effect of PDEi use on SB scores in men who are potent post radical prostatectomy. PATIENTS AND METHODS The study population consisted of patients who were potent both before and after radical prostatectomy, with at least 2 years of follow-up. Disease-specific quality of life data were evaluated by the University of California, Los Angeles, Prostate Cancer Index (PCI) survey. The relationships between changes in sexual function (SF) and SB and use of PDEi over time were evaluated by mixed model analysis controlling for age, clinical risk group, marital status, and time of PCI assessment. RESULTS Of the 246 patients who met the study criteria, 39% reported PDEi use at some point after treatment. PDEi use was not associated with improved SF (P= 0.81). Furthermore, PDEi use was not associated with a change in SB (P= 0.36). Both SF and SB were significantly associated with time of assessment and age, and SF and SB each improved over time. In addition, SB was significantly associated with marital status. CONCLUSIONS In this analysis, there was no difference in SF scores between men who were potent with or without the use of PDEi. Furthermore, there was no difference in SB scores between men who were potent with or without the use of PDEi. This suggests that the current, inclusive, definition of potency is valid with respect to SB.
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Affiliation(s)
- Sanoj Punnen
- Department of Urology, University of California, San Francisco, CA, USA.
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Mitchell SA, Jain RK, Laze J, Lepor H. Post-Prostatectomy Incontinence During Sexual Activity: A Single Center Prevalence Study. J Urol 2011; 186:982-5. [DOI: 10.1016/j.juro.2011.04.088] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Indexed: 11/28/2022]
Affiliation(s)
| | - Rajat K. Jain
- New York University Langone Medical Center, New York, New York
| | - Juliana Laze
- New York University Langone Medical Center, New York, New York
| | - Herbert Lepor
- New York University Langone Medical Center, New York, New York
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Maluta S, Dall'oglio S, Nadalini L. Treatment for intermediate and high-risk prostate cancer: controversial issues and the role of hyperthermia. Int J Hyperthermia 2011; 26:765-74. [PMID: 21043571 DOI: 10.3109/02656736.2010.509749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
For patients affected by intermediate- and high-risk prostate cancer, a single local therapy is not enough, and a more aggressive treatment, such as androgen suppression therapy (AST) and pelvic irradiation, is indicated. Biochemical disease-free survival (bDFS) and overall survival (OS) improve in intermediate- and high-risk prostate cancer using radiotherapy (RT) combined with AST as compared with the RT alone. Hyperthermia (HT), combined with RT for the treatment of prostate cancer with intermediate- and high-risk, has been defined as "promising". In the development of new strategies, the reduction of short and long-term treatment related toxicity is of primary importance. Quality of Life (QoL) has been previously investigated and the authors concluded that HT does not negatively impact QoL in patients treated with radiation and HT. The use of HT in treating advanced prostate cancer has been reported by many centres; several studies suggest the feasibility of HT added to conventional RT. In intermediate- and high-risk prostate cancer, the combination of RT plus a long-term androgen suppression provides good results in terms of OS and QoL. HT, improving the anti-cancer effects of irradiation, as demonstrated by experimental in vitro and in vivo studies, could increase the outcome in the treatment of locally advanced prostate tumours without adding toxicity. A randomised phase III trial comparing RT-AST combined treatment plus/minus HT is needed to demonstrate the efficacy of HT.
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Affiliation(s)
- Sergio Maluta
- Radiation Oncology Department, University Hospital, Verona, Italy.
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Athermal Division and Selective Suture Ligation of the Dorsal Vein Complex During Robot-Assisted Laparoscopic Radical Prostatectomy: Description of Technique and Outcomes. Eur Urol 2011; 59:235-43. [DOI: 10.1016/j.eururo.2010.08.043] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 08/26/2010] [Indexed: 11/22/2022]
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Abstract
Many options exist for the treatment of localized prostate cancer. In the decision to choose a therapeutic option for localized disease, many variables need to be considered such as tumor characteristics, clinical stage, the patient's overall health and life expectancy, and preferences of both the physician and patient. Another important consideration is the health-related quality of life (HRQOL) implications of a given treatment option. The importance of HRQOL relative to the potential side effects of prostate cancer treatments has grown over the past few years. Although our collective awareness has increased, objective data on HRQOL for prostate cancer treatment are lacking due to a paucity of prospective clinical trial data. This review defines the concept of HRQOL, discusses what is currently known about the impact of various treatments on HRQOL, and summarizes the recent literature in this area relating to the management of localized prostate cancer.
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Gore JL, Gollapudi K, Bergman J, Kwan L, Krupski TL, Litwin MS. Correlates of bother following treatment for clinically localized prostate cancer. J Urol 2010; 184:1309-15. [PMID: 20723914 DOI: 10.1016/j.juro.2010.06.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE We determined factors associated with bother, the distress patients experience as a result of functional detriments after treatment for localized prostate cancer. MATERIALS AND METHODS A prospective cohort of men treated for clinically localized prostate cancer completed a questionnaire comprising the UCLA-PCI, Medical Outcomes Study Short Form-36, American Urological Association Symptom Index and Memorial Anxiety Scale for Prostate Cancer fear of recurrence subscale. We used nonlinear mixed models to identify factors associated with severe urinary, sexual and bowel bother. RESULTS Worse function scores were associated with severe urinary, sexual and bowel bother following treatment (OR 0.88-0.94, p <0.001). Worse American Urological Association Symptom Index score was associated with severe urinary bother (OR 1.22, 95% CI 1.16-1.28). Time since treatment was inversely associated with urinary (OR 0.68, 95% CI 0.54-0.83) and bowel bother (OR 0.63, 95% CI 0.47-0.80) early after treatment but not for the entire 48-month study period. Receipt of concomitant androgen deprivation therapy was not associated with bother 48 months after radiation. CONCLUSIONS Addressing functional detriment may confer improvement in urinary, sexual and bowel bother. Patient distress related to dysfunction improves with time. Measuring health related quality of life after prostate cancer treatment should incorporate functional and bother assessments.
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Affiliation(s)
- John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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