COMPLEX UNDERPINNINGS

Some researchers have argued that an emphasis on pharmaceutical monotherapy for erectile dysfunction reflects a fundamental flaw in assumptions about sexual dysfunction following prostate cancer treatment. 2,8 Such approaches run the risk of neglecting other facets of the complex and multifactorial psychosexual roots of sexual dysfunction among men with prostate cancer. And that can obscure the potential of other promising interventions.

A small but growing body of evidence suggests physical exercise addresses several underlying risk factors that might help improve libido and sexual activity among men with prostate cancer.2 Preliminary findings suggest that these include reduced body feminization, particularly increased muscle mass and more typically masculine body fat distribution; reduced fatigue, depression, and anxiety; increased aerobic capacity and stamina; and improved overall quality of life.2


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COMMUNICATION IS KEY

Psychosexual consequences of radiotherapy and other prostate cancer treatments are well known to clinicians but are frequently unanticipated among patients and their partners.8 Sildenafil has been available since 1998, and has improved men’s willingness to discuss post-cancer therapy sexual dysfunction and treatment options with their doctors.9

Yet, studies show clinicians tend to avoid talking about sexual dysfunction with their patients.8,9 “Our study illustrates that health care professionals have the potential to do much more to prepare men and their partners for these impacts,” Liz Forbat, PhD, lead author of one such study,8 told Oncology Nurse Advisor. Her team’s study found that even though partners frequently participate in urology and radiotherapy consultations, they are rarely involved directly in discussions; sexual functioning and wider psychosexual concerns were rarely discussed.8

“Clinicians often worry that asking about sexual functioning may ‘open a can of worms,’ leaving the patient and partner feeling overwhelmed, and the clinician unable to offer adequate support and advice,” explained Forbat, who is codirector of the Cancer Care Research Center at the School of Nursing, Midwifery and Health at the University of Stirling, in Scotland.

Tools such as the Expanded Prostate Cancer Index Composite (EPIC) questionnaire can help assess men’s physical function and distress, and it can also serve as a useful way to initiate discussions about sexual function. “Importantly, this tool provides health care professionals with a structure for opening up conversation about the most intimate impacts of prostate cancer treatments,” Forbat said. “Clinicians can then ask gentle exploratory questions about items on the tool where the man identifies difficulties, and this can be very powerful in clinicians identifying potential solutions.”

Research including her team’s study “demonstrates that patients often welcome the opportunity to talk about the impact on their sexual functioning, and the ‘can of worms’ looks less worrying when the lid has been lifted,” Forbat said.


Bryant Furlow is a medical journalist based in Albuquerque, New Mexico. 


REFERENCES

1. Pisansky TM, Pugh SL, Greenberg RE, et al. Tadalafil for prevention of erectile dysfunction after radiotherapy for prostate cancer: the Radiation Therapy Oncology Group [0831] randomized clinical trial. JAMA. 2014;311(13):1300-1307. doi:10.1001/jama.2014.2626.

2. Cormie P, Newton RU, Taaffe DR, et al. Exercise therapy for sexual dysfunction after prostate cancer. Nature Rev Urol. 2013;10(12):731-736. doi:10.1038/nrurol.2013.206.

3. Obayomi-Davies O, Chen LN, Bhagat A, et al. Potency preservation following stereotactic body radiation therapy for prostate cancer. Radiat Oncol. 2013;8:256. doi:10.1186/1748-717X-8-256. http://www.ro-journal.com/content/8/1/256. Accessed May 7, 2014.

4. Bhattasali O, Chen LN, Woo J, et al. Patient-reported outcomes following stereotactic body radiation therapy for clinically localized prostate cancer. Radiat Oncol. 2014;9:52. doi:10.1186/1748-717X-9-52. http://www.ro-journal.com/content/9/1/52. Accessed May 7, 2014.

5. Haliloglu A, Baltaci S, Yaman O. Penile length changes in men treated with androgen suppression plus radiation therapy for local or locally advanced prostate cancer. J Urol. 2007;177(1):128-130.

6. Park KK, Lee SH, Chung BH. The effects of long-term androgen deprivation therapy on penile length in patients with prostate cancer: a single-center, prospective, open-label observational study. J Sex Med. 2011;8(11):3214-3219. doi:10.1111/j.1743-6109.2011.02364.x.

7. Zelefsky MJ, Shasha D, Branco RD, et al. Prophylactic sildenafil citrate for improvement of erectile function in men treated by radiotherapy for prostate cancer. J Urol. In press. doi:10.1016/j.juro.2014.02.097.

8. Forbat L, White I, Marshall-Lucette S, Kelly D. Discussing the sexual consequences of treatment in radiotherapy and urology consultations with couples affected by prostate cancer. BJU Int. 2012;109(1):98-103. doi:10.1111/j.1464-410X.2011.10257.x.

9. Furlow B. Sexual dysfunction in patients with lung disease [published online ahead of print May 2, 2014]. Lancet Respir Med. doi:10.1016/S2213-2600(14)70081-5.