Elyse Watkins, DHSc, PA-C, DFAAPA
Management of sexual dysfunction is a very common issue after treatment for prostate cancer 1. The incidence of occurrence of sexual dysfunction concluding treatment for prostate cancer can be a major barrier to treatment for many men considering their options of therapy. Many patients often reluctantly decide on surveillance instead of active treatment due to the significant risk of sexual dysfunction. Prostatectomy and radiation therapy are the two most commonly recommended active treatment options utilized currently; both having equally high cure rates but considerable side effects on sexual health. Patients choosing to undergo active treatment look to providers to help them decide which option will least impact their sexual well-being. Too often the long term consequences of treatments are not part of the treatment discussion with patients. Our duty as providers is to provide these patients with the most comprehensive information to make the best informed decision.
A PubMed and JSTOR literature search provided twelve articles pertinent to this topic. Search phrases utilized were: prostate cancer management, sexual dysfunction, total prostatectomy, external beam radiation sexual dysfunction.
Review of several randomized trials to include the SPIRIT trial show a significantly decreased health-related quality of life (HRQOL) score with prostatectomy versus radiation. The HRQOL scores were evaluated with the use of prostate cancer–specific 50-item Expanded Prostate Cancer Index Composite (EPIC), Short Form 12 Physical Component Score (SF-12 PCS), Short Form 12 Mental Component Score (SF-12 MCS).2 Results from formal questionnaires revealed greater incidences of urinary and sexual dysfunction than that reported during physician encounters.
The most common treatment options for prostate cancer have considerable side effects that affect the quality of life for men. Studies have shown that patients after treatment often under report the degree of urinary and sexual symptoms experienced. With the incidence of incontinence and sexual dysfunction at near 50% at 5 year follow ups, the importance of education of patients cannot be underscored.
Meyer CJ. Sexual Dysfunction After Prostate Cancer Treatment: Patient Education of Optimal Treatment Choices for Risk Reduction. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2020; 2(2).
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