A comparative study of erectile function and use of erectile aids in high-risk prostate cancer patients after robot-assisted laparoscopic prostatectomy

Experiences of Support for Sexual Dysfunction in Men With Prostate Cancer: Findings From a U.K.-Wide Mixed Methods Study

BACKGROUND

Men with prostate cancer (PCa) often experience sexual dysfunction following diagnosis and treatment, yet little is known about the support they receive to deal with this.

AIM

To explore men's experiences of support for sexual dysfunction following PCa diagnosis.

METHODS

This study included a U.K.-wide survey of men 18-42 months post-diagnosis of PCa, identified through cancer registries. The survey measured sexual function and the extent to which men perceived sexual dysfunction to be a problem (Expanded Prostate Cancer Index Composite-26), access to and experience of medications, devices, and specialist services for sexual dysfunction, and included a free-text question for further comments. Analysis focussed on men who reported poor sexual function, which they considered a moderate or big problem. Descriptive statistics explored the characteristics of men offered intervention and those that found this helpful. Free-text responses were analyzed using thematic analysis.

OUTCOME

The main outcome of this study was to assess access to and experience of medications, devices, and specialist services for sexual dysfunction.

RESULTS

39.0% of all survey respondents (13,978/35,823) reported poor sexual function, which they considered a moderate or big problem. 51.7% of these men were not offered any intervention to aid sexual functioning. 71.9% of those offered an intervention reported trying it, of whom 48.7% found the intervention helpful. Men treated with surgery or brachytherapy were most likely to be offered an intervention. Medication was the most commonly offered intervention and 39.3% of those who tried medication found this helpful. Although offered less often, approximately half of the men who tried devices or attended specialist services found the intervention helpful. Free-text responses indicated that barriers to accessing support included inadequate information and support from healthcare professionals, embarrassment, negative views about treatment options, concerns about side effects and safety, and inconsistencies between secondary and primary care. Barriers to continuing use included limited effectiveness of treatments, inadequate ongoing support, and funding constraints. Drivers of sexual recovery included patient proactivity and persistence with trying different treatment options and ongoing support from health professionals.

CLINICAL IMPLICATIONS

There is an urgent need to ensure that all men are offered, and have equal access to, sexual care support, with referral to specialist services when required.

STRENGTHS & LIMITATIONS

This study presents data from a large, U.K.-wide, population-based study of men with PCa and includes quantitative and qualitative findings. The possibility of non-response bias should, however, be considered.

CONCLUSION

There are significant shortcomings in the support offered to U.K. men with sexual dysfunction following diagnosis and treatment for PCa which need to be addressed. Watson E, Wilding S, Matheson L, et al. Experiences of Support for Sexual Dysfunction in Men With Prostate Cancer: Findings From a U.K.-Wide Mixed Methods Study. J Sex Med 2021;18:515-525.

Recent Advances in the Management of High-Risk Localized Prostate Cancer: Local Therapy, Systemic Therapy, and Biomarkers to Guide Treatment Decisions

High-risk prostate cancer accounts for approximately 15% of all prostate cancer diagnoses. Patients with high-risk disease have an increased risk of developing biochemical recurrence, metastases, and death from prostate cancer. As the optimal management of high-risk disease in patients with prostate cancer continues to evolve, the contemporary treatment paradigm is moving toward a multidisciplinary integrated approach of systemic and local therapy for patients with high-risk disease. The strategies for definitive, adjuvant, and salvage local treatment, including radical prostatectomy or radiation therapy, serve as the backbone of therapy for patients with localized disease. Systemic therapy decisions regarding use in combination with surgery, choice of therapy (hormone therapy, chemotherapy), and treatment duration continue to be refined. As more effective hormonal agents populate the treatment landscape for advanced prostate cancer, including abiraterone and next-generation antiandrogens, an opportunity is provided to explore these treatments in patients with localized disease in the hope of improving the long-term outcome for patients. Integration of innovative blood and tissue-based biomarkers to guide therapy selection for patients with high-risk disease is an area of active research. Contemporary studies are using such biomarkers to stratify patients and select therapies. In this review, we summarize contemporary evidence for local treatment strategies, systemic therapy options, and biomarkers in development for the management of high-risk prostate cancer in patients.

Psychometric properties of the expanded prostate cancer index composite - 26 instrument in a cohort of radical prostatectomy patients: theoretical and practical examinations

Background

Recently, the Expanded Prostate Cancer Index Composite 26-item version (EPIC-26) was recommended for the assessment of adverse effects after the treatment of prostate cancer without clear reasons. This decision encouraged us to review the questionnaire development from the UCLA Prostate Cancer Index (UCLA-PCI) to the EPIC-16 CP with a focus on psychometric properties. We also reviewed PubMed for papers concerning such properties of the EPIC-26 since 2012 (latest review in 2011). Finally, we examined the psychometric properties of the EPIC-26 in a sample of Norwegian males treated with robot-assisted laparoscopic prostatectomy (RALP).

Methods

This study used three methods: (1) Comparison of the content of the UCLA-PCI, EPIC-50, EPIC-26, and EPIC-16 CP; (2) Review of EPIC-26 and EPIC-16 CP papers in PubMed from 2012 to 2016, identifying papers reporting on the psychometric properties of these questionnaires; and (3) Psychometric examination of the EPIC-26 rating in 651 Norwegian men treated with RALP at a mean of 3.2 years post-surgery.

Results

The questionnaire development showed a significant increase in bother versus function items, and the EPIC-26 contains eight function and 18 bother items. Twelve papers concerning the EPIC-26 available on PubMed since 2012 support the psychometric properties of the EPIC-26. The Norwegian EPIC-26 findings supported the psychometric properties of the EPIC-26, but suggested six subdomains both by exploratory and confirmatory factor analyses.

Conclusions

In general our examinations supported the adequate psychometric properties of the EPIC-26, although the factor structure, construct and predictive validity of the instrument should be examined further.

A Retrospective Study of Erectile Function and Use of Erectile Aids in Prostate Cancer Patients After Radical Prostatectomy in Denmark

INTRODUCTION

Radical prostatectomy (RP) offers a good long-term cancer control for clinically localized prostate cancer. However, complications such as erectile dysfunction and substantial decreases quality of life of the afflicted men and their sexual partners. Identification of pre-, per-, and postoperative factors that correlate with poor postoperative erectile status must be considered an important step to improving penile rehabilitation.

AIM

To describe postoperative erectile function after RP in a Danish cohort.

METHODS

The medical records of 1,127 patients undergoing RP from March 2003 through September 2014 were reviewed retrospectively with a 12-month follow-up after surgery. In all, 704 patients fulfilling the inclusion criteria were included in the final analysis. Recovery was defined as self-reported erection sufficient for intercourse (ESI) with or without usage of erectile aids.

MAIN OUTCOME MEASURES

Subjective reporting of erectile function and usage erectile aids 12 months after RP.

RESULTS

ESI with or without erectile aids was reported by 226 men (32.1%), among whom 109 (48.2%) required erectile aids. Erectile dysfunction (ED) was reported by 478 men (67.9%) and by 121 (25.3%) despite use of erectile aids. Of men with ED, 155 (22%) stated not being interested in penile rehabilitation, 26 (3.7%) stated not having resumed their sex life 12 months after RP, and 241 (34.2%) had ED and were unsatisfied with the condition. We found that 134 of 445 men (30.1%) who underwent non-nerve-sparing RP had ESI 12 months after RP. Age older than 60.5 years, a high body mass index, comorbidity, and a high American Society of Anesthesiologists score were negative predictors of erectile function 12 months after RP.

CONCLUSION

Twelve months after RP, 32.1% of men had ESI; half these men required the use of erectile aids. Age older than 60.5 years, a high body mass index, comorbidity, and a high American Society of Anesthesiologists score were negative predictors for ED 12 months after RP. Haahr MK, Azawi NH, Andersen LG, et al. A Retrospective Study of Erectile Function and Use of Erectile Aids in Prostate Cancer Patients After Radical Prostatectomy in Denmark. Sex Med 2017;5:e156-e162.

The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review

CONTEXT

There is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa).

OBJECTIVE

To systematically review the relevant literature assessing the relative benefits and harms of PLND for oncological and non-oncological outcomes in patients undergoing radical prostatectomy for PCa.

EVIDENCE ACQUISITION

MEDLINE, MEDLINE In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched up to December 2015. Comparative studies evaluating no PLND, limited, standard, and (super)-extended PLND that reported oncological and non-oncological outcomes were included. Risk-of-bias and confounding assessments were performed. A narrative synthesis was undertaken.

EVIDENCE SYNTHESIS

Overall, 66 studies recruiting a total of 275,269 patients were included (44 full-text articles and 22 conference abstracts). Oncological outcomes were addressed by 29 studies, one of which was a randomized clinical trial (RCT). Non-oncological outcomes were addressed by 43 studies, three of which were RCTs. There were high risks of bias and confounding in most studies. Conflicting results emerged when comparing biochemical and clinical recurrence, while no significant differences were observed among groups for survival. Conversely, the majority of studies showed that the more extensive the PLND, the greater the adverse outcomes in terms of operating time, blood loss, length of stay, and postoperative complications. No significant differences were observed in terms of urinary continence and erectile function recovery.

CONCLUSIONS

Although representing the most accurate staging procedure, PLND and its extension are associated with worse intraoperative and perioperative outcomes, whereas a direct therapeutic effect is still not evident from the current literature. The current poor quality of evidence indicates the need for robust and adequately powered clinical trials.

PATIENT SUMMARY

Based on a comprehensive review of the literature, this article summarizes the benefits and harms of removing lymph nodes during surgery to remove the prostate because of PCa. Although the quality of the data from the studies was poor, the review suggests that lymph node removal may not have any direct benefit on cancer outcomes and may instead result in more complications. Nevertheless, the procedure remains justified because it enables accurate assessment of cancer spread.

Global Quality of Life After Curative Treatment for Prostate Cancer: What Matters? A Study Among Members of the Norwegian Prostate Cancer Patient Association

INTRODUCTION

The purpose of this study was to identify factors that are associated with quality of life (QoL) in relapse-free patients after radical prostatectomy or high-dose radiotherapy with or without hormone treatment.

PATIENTS AND METHODS

A cross-sectional postal survey among members of the Norwegian Prostate Cancer Patient Association was used. We analyzed associations between QoL and general health, "typical" adverse effects (sexual, urinary, and bowel assessed using the Expanded Prostate Cancer Composite items) and psychosocial variables (work ability, family life, social life and/or leisure activities) in univariate and multivariate regression analyses. Statistical significance was defined as P < .01.

RESULTS

Among 612 responders (approximately 50% compliance; median age, 70 years), in univariate analyses QoL was significantly associated with functional aspects and the level of bother within the sexual, urinary, and bowel domains and with general health and psychosocial aspects of daily life. In the multivariate analysis only general health and social life and/or leisure activities remained associated with QoL, with work ability being a third factor in patients younger than 65 years old. Posttreatment worsening of partnership was reported by 12% of the patients.

CONCLUSION

Prostate cancer patients who are to undergo curative treatment should be informed about the risk of reduced function within the sexual, urinary, and bowel domains, but also about these dysfunctions' relation to bother and QoL, considered together with the patients' general health and their preferences as to their social life activities.