The use of treatments for erectile dysfunction among survivors of prostate carcinoma

Abstract

BACKGROUNDThe objectives of this survey were to describe the prevalence of using a treatment for erectile dysfunction (ED) among men after therapy for localized prostate carcinoma and to construct models explaining the variance in trying a treatment, treatment success, and adherence to treatment.METHODSA postal survey was sent to 2636 men in The Cleveland Clinic Foundation's Prostate Cancer Registry who were treated initially with either definitive radiotherapy or prostatectomy for localized prostate carcinoma. The survey asked about demographic items, past and current sexual functioning, and the partner's sexual function. Men were asked about their current and intended use of medical treatments for ED. Standardized questionnaires included the Sexual Self‐Schema Scale‐Male Version, the International Index of Erectile Function, urinary and bowel symptom scales from the Los Angeles Prostate Cancer Index), and the Short‐Form Health Survey.RESULTSThe return rate was 49%. Differences between men who returned the questionnaire and men who did not respond suggest that the sample was weighted toward men who were more interested in staying active sexually. ED was a problem for 85% of men, and 59% of this group used at least 1 treatment for ED. Only 38% of men found that a medical treatment was at least somewhat helpful in improving their sex lives, however, and 30% of respondents still were using at least 1 treatment at the time of the survey. Factors that were associated with the efficacy of treatments for ED and with their continued use included having a sexual partner, younger age, choosing a treatment for prostate carcinoma that was more likely to spare some sexual function, and not having had neoadjuvant or current antiandrogen therapy. Men who tried a greater number of treatments for ED were more likely to find one that worked. Men were more likely to continue using treatments for ED that produced greater improvements in sexual function.CONCLUSIONSThe success of medical treatments for men with ED among long‐term survivors of prostate carcinoma is limited. Men prefer noninvasive treatments, although invasive treatments are more effective. Sexual counseling for men and their partners is recommended, because it may increase the use of medical therapies for ED. Creating more realistic expectations in both partners also may enhance treatment adherence. Cancer 2002;95:2397–407. © 2002 American Cancer Society.DOI 10.1002/cncr.10970

Erectile dysfunction and sexual health after radical prostatectomy: impact of sexual motivation

“…5 To improve patients' and their partners' sex-lives, it is thus necessary not only to treat the mechanics (ED treatment), but also to provide appropriate psychological or sexual counseling to help cope with the impact of RP on sexual desire and orgasm. 6,28 In our study, the patients who were most motivated to remain sexually active after RP (Group 1) experienced a greater degree of bother and had a lower overall sexual satisfaction score than the less motivated patients. Their satisfaction score was very low (0.5/10) when they were not receiving ED treatment but higher on treatment (3.9/10), thus confirming the benefit of treatment in motivated patients.…”

“…6 The issue of ED treatment is raised after surgery, once anxiety over surgery is over and patients have received reassurance about their cancer treatment. Some patients request sexual management promptly, others do not.…”

The psychosocial aspects of sexual recovery after prostate cancer treatment

“…32 Factors that characterize men seeking help are younger age, available sexual partners, better physical and psychological health, more education, greater financial well being and nerve-sparing surgical treatment. 3,4,33 Schover et al 26 found that men with sexual self-confidence and positive attitudes toward obtaining help were more likely to seek help than others, and that help seeking may be associated with the earliest stage of illness, before biochemical failure. 33 Matthew et al 3 hypothesize that psychological barriers may affect men's help seeking for erectile dysfunction.…”

“…3,4,33 Schover et al 26 found that men with sexual self-confidence and positive attitudes toward obtaining help were more likely to seek help than others, and that help seeking may be associated with the earliest stage of illness, before biochemical failure. 33 Matthew et al 3 hypothesize that psychological barriers may affect men's help seeking for erectile dysfunction. They suggest that a biopsychosocial model of care, provided by a multidisciplinary team that would include professionals with expertise in sexual counseling might help remove these barriers.…”

Discovery and horizontal follow-up of an autoantibody signature in human prostate cancer

“…The introduction of diagnostic serum biomarkers into clinical practice, such as prostate-specific antigen (PSA), has greatly improved early detection of the disease (2). However, the lack of reliable methods for prediction of progression beyond early-stage disease and the paucity of treatment options for patients with bone metastasis results in many patients with localized disease subjected to aggressive treatment with sequelae including incontinence and impotence (3). Thus, identification of biomarkers to improve the accuracy of clinical assessment and stratification of patients needing conservative versus aggressive treatment would constitute a major advance in the management of this disease.…”