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Prostate Cancer Issues
Ernest H. Rosenbaum, MD

Sexual Problems With Prostate Cancer
Sexual Dysfunction in Men with Prostate Cancer: Psychosocial Issues

Sexual Problems With Prostate Cancer
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Sexual dysfunction is not an uncommon problem. These include erectile dysfunction, anejaculation, anorgasmia and dysorgasmia (painful ejaculation), urinary leaks, and alteration in penile length and curvature. These problems affect quality of life and in some patients can be an unacceptable side effects. It is not uncommon that patients having radical prostatectomy even with a nerve-sparing procedure. In one study, where 81% had a baseline of an erection adequate for intercourse following surgery had reduced success with only 17% at twelve month and 22% at 24 months having successful intercourse. Younger patients fared better than older patients. 2

Sixty-one percent of the patients reported distress about erectile dysfunction (ED), and 38% found that sildenafil (Viagra) had about a 38% response rate for improved sexual function.

In studies on Sildenafil, there were improved erections in 50% of men after unilateral nerve-sparing surgery and 72% after bilateral nerve-sparing surgery. In another study, 52% effectiveness was found with tadalafil (Cialis) in patients with some residual erectile dysfunction. Of note is that after age 60, the use of Sildenafil becomes less effective.

In patients with unilateral nerve-sparing surgery, functional erections were reported in 13% without medication, and an additional 6% with medication following radical prostatectomy, 5-6% for brachytherapy, and 19% and 7% respectively for functional erections.

Other treatments, including penis intracavernosal injections, with a 60-70% success rate, and a transurethral penis prostaglandin suppository had a 40% effectiveness. The use of nightly Sildenafil for 36 weeks after surgery helped reduce erectile dysfunction.

Sexual Dysfunction in Men with Prostate Cancer: Psychosocial Issues
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In Dr. Schover's study, she noted that younger patients did better if sexually successful before cancer therapy. A treatment modality was chosen based on the preservation of sexual function. They were more successful If they had undergone bilateral nerve-sparing surgery or brachytherapy (radiation), and had not received concurrent hormone therapy, and were in good mental and physical health. 2

Psychological counseling for sexual distress can be helpful in the rehabilitation process for both partners. The goal is to reduce negative thoughts about sex and improve sexual communication and lovemaking skills to cope with incontinence and vaginal dryness of the partner and to help improve affection and coping with the illness.

By adopting these practices there was generally an improvement in erectile dysfunction.

Dr. Schover's conclusion was that six months of psychological supportive treatments improved sexual function and satisfaction for both men and women and diminished the men's emotional stress, although, benefits were not always sustained over time. A web-based program is also available through M. D. Anderson Hospital, which has also been found to be helpful. Face-to-face counseling was superior to telephone and web support, but she felt that a combination of both website and brief counseling showed promise.

Counseling should be made available.

2. Schover, L. R., Professor of Behavioral Science at the M. D. Anderson Hospital, Journal of Oncology, vol. 5., 2, February 2007, pg. 91-92

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