Quality of Life, Sexual Functioning and Sex Role Identity After Surgical Orchidectomy in Patients with Prostatic Cancer

Abstract

Surgical orchidectomy is a simple procedure with few physical side effects, low mortality, and cost effectiveness. Nevertheless, there can be negative sequelae such as sexual dysfunction, impaired quality of life, and poor body image. Although it is a frequent treatment approach for prostate cancer, it is not clear whether these sequelae are problematic for this patient group. It is possible that relief from painful metastases and the prolongation of life outweigh these negative factors. The present study investigated quality of life, sex-role identity, and sexual function in 15 patients with stage D prostate cancer, before and after surgery. Orchidectomy did not appear to affect quality of life, or sex-role identity. However, loss of sexual function did present as an area of concern. It was noted that 55% of premorbidly sexually active patients found this loss disturbing. These patients, premorbidly, appeared to have higher sex-role stereotypy.

Is there a role for antiandrogen monotherapy in patients with metastatic prostate cancer?

“…This can adversely affect patient quality of life, an important consideration in this palliative setting. In particular, libido and sexual potency are generally diminished 2,3 and this may be unacceptable to some men. Additionally, some patients may have personal reasons for avoiding castration, may prefer oral therapy, or may not tolerate LHRH agonist therapy.…”

Distress due to unwanted side-effects of prostate cancer treatment is related to impaired well-being (quality of life)

“…2 It has been argued that side-effects of prostate cancer treatment including waning sexual function and urinary and bowel symptoms, do not affect the quality of life among prostate cancer patients in spite of reported distress due to these symptoms. 3,4 Available data, however, are compromised by a large non-response and the use of psychometric scales that may be insensitive, leaving the issue open for debate. If quality of life after treatment is immediately affected in elderly men as a result of, for example waning sexual function, this must be balanced against possible long-term treatment bene®ts.…”

Treatment of Locally Advanced Prostate Cancer – A New Role for Antiandrogen Monotherapy?

“…The side effects of the hypoandrogenic state following castration are well documented and include erectile dysfunction and loss of libido [25, 26], hot flushes [27], osteoporosis [28, 29, 30], and a reduction in muscle mass and strength [31, 32]. …”