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Prostate cancer survivorship and psychosexual function: a silent epidemic

Sir,

We were delighted to read the comment by Vasdev et al. [1]. This is an important topic relating to prostate cancer survivorship which is currently unaddressed.

One of the problems survivors encounter post-therapy is psychosexual concerns [2]. These are critical to manage appropriately. With individualised treatment options, survivors may be able to gain a significant improvement in sexual function. In addition, a reduction in quality-of-life is related to sexual dysfunction after completing cancer treatment [3]. A study found that survivors report being significantly concerned about sexual function, yet few seek help for sexual problems [4].

Men who have undergone radical prostatectomy experience greater stress on relationships than men receiving external beam radiation therapy, perhaps due to the fact that they are younger. Younger men have greater concerns and are more sexually active. In two retrospective cohort studies, men receiving nerve sparing surgery at age 39–54 were more likely than older men and men receiving non-nerve sparing surgery, to report erections firm enough for intercourse [5,6].

NICE guidance on prostate cancer requires sexual dysfunction to be addressed as part of survivorship care, with early access to services post-therapy [5]. Currently, this is not fully addressed in many centres. In addition it has been found that ‘more motivated’ patients experienced greater distress from their sexual dysfunction postoperatively [7].

Postoperative management of patients who have had radical therapy for prostate cancer should take the patients’ individualised psychosexual concerns into account [8].

Goonewardene SS*, Young A**, Persad R***
*Guys Hospital, Kings College London, **Warwick Medical School, ***North Bristol NHS Trust

References

  1. Vasdev N, Hoyland K, Adshead JM. Is it still clinically and economically viable in the UK to prescribe vacuum erection devices for patients with erectile dysfunction after radical prostatectomy? BJU Int 2014; 113: 356-57
  2. Northouse LL, Mood DW, Schafenacker A, et al. Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer 2007; 110: 2809-18
  3. Descazeaud A, Zerbib M, Hofer MD, Chaskalovic J, Debré B, Peyromaure M. Evolution of health-related quality of life two to seven years after retropubic radical prostatectomy: evaluation by UCLA prostate cancer index. World J Urol 2005; 23: 257-62
  4. Galbraith ME, Arechiga A, Ramirez J, Pedro LW. Prostate cancer survivors’ and partners’ self-reports of health-related quality of life, treatment symptoms, and marital satisfaction 2.5-5.5 years after treatment. Oncol Nurs Forum 2005; 32: E30-41
  5. Penson DF, McLerran D, Feng Z, et al. 5-Year urinary and sexual outcomes after radical prostatectomy: Results from the prostate cancer outcomes study. J Urol 2005; 173: 1701-05
  6. Sandblom G, Ladjevardi S, Garmo H, Varenhorst E. The impact of prostate-specific antigen level at diagnosis on the relative survival of 28,531 men with localized carcinoma of the prostate. Cancer 2008; 112: 813-9
  7. Song L, Northouse LL, Braun TM, et al. Assessing longitudinal quality of life in prostate cancer patients and their spouses: a multilevel modeling approach. Qual Life Res 2011; 20: 371-81
  8. Namiki S, Ishidoya S, Ito A, Arai Y. Abstract 671: The impact of sexual desire on sexual health related quality of life following radical prostatectomy: A 5-year follow up study in Japan. 27th Annual Congress of the European Association of Urology Eur Urol Suppl 2012; 11: e671

 

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