Dr Karen Robb
Programme Implementation Director – Cancer, Movember
Poor sexual function is the most common side effect of prostate cancer treatment, but personalised healthcare can improve men’s quality of life.
When Elvin Box, now 65, was diagnosed with aggressive prostate cancer in 2016, he felt lucky that the disease had been discovered before it became incurable. However, he was unprepared for the impact on his sex life, 41-year marriage and his mental health.
In the UK, prostate cancer is the most diagnosed cancer in men1 and more than 395,000 were living with or beyond prostate cancer in 2018.2 Prostate cancer therapies can negatively impact men’s sexual function and lead to changes in their relationships. Appropriate care and information are not always available.
Sexual side effects of treatment
According to the Movember-funded ‘Life After Prostate Cancer Diagnosis’ (LAPCD) study, 79% of men reported poor sexual function as a side effect of prostate cancer treatment.
Among many potential side effects, men on hormonal therapy may experience decreases in their sex drive because of the loss of testosterone and possible loss of orgasm. Surgery and radiotherapy can damage nerves, blood vessels and muscles which diminishes erectile function.
Unfortunately, it remains a problem that is not routinely addressed in prostate cancer care. The LAPCD study, published in The Lancet in 2019, found that 57% of men were not offered any help with sexual dysfunction following their treatment.3
79% of men reported poor sexual function as a side effect of prostate cancer treatment.
New guidelines for healthcare professionals
Earlier this year, the needs of men and their partners have finally been addressed with the publication of new clinical guidelines for prostate cancer care in The Journal of Sexual Medicine. The guidelines are based on decades of research and combined international expert perspectives.
Reasons for healthcare professionals (HCPs) not having conversations about sex include a lack of knowledge, discomfort with the conversation, perceived or imagined patient discomfort and lack of time. However, research shows that patients and partners are unlikely to initiate discussions about sexual concerns, so HCPs must feel confident and adequately equipped to introduce the topic and set realistic expectations of sexual issues early on.
The guidelines provide a framework to prepare HCPs to initiate these sensitive conversations, provide tailored care to enhance sexual health and facilitate shared decision-making between clinicians, patients and their partners. They provide a holistic model of care that recognises cultural, ethnic, racial, sexual and gender diversity as well as differences across healthcare systems.
Assessment of sexual function and wellbeing, prior to, during and after treatment would ensure that issues are raised in a timely way and early interventions can be implemented to address someone’s physical, emotional and social needs.
Rebuilding your sex life
The good news is that, with appropriate care and support, sexual health and intimacy can be re-established and enhanced after prostate cancer treatment for men and their partners.
Addressing sexual health and recovery is the responsibility of every HCP who touches the life of a prostate cancer patient. Now, we have an inclusive roadmap that will allow healthcare providers to address the needs of their patients.
Understanding that many prostate cancer patients live long lives — some with and without partners — requires us to help protect and enhance the quality of their lives during and beyond treatment. By including sexual health as a part of usual care, we will be responding to significant unmet needs and achieving a new standard of care.
Box, now an ambassador for Movember, says: “If only the guidelines had been there for me. If they’re now used by healthcare professionals, it will help so many men faced with the trauma of dealing with prostate cancer to make an informed decision about their choice of treatment and how they can rehabilitate.”
To read the guidelines, visit: movember.com/SexualHealthGuideline
[1] https://gco.iarc.fr/today/
[2] https://www.cancerdata.nhs.uk/prevalence
[3] Quality of Life in Men Living with Advanced and Localised Prostate Cancer: A UK population-wide patient-reported outcome study of 30,000 men – The Lancet Oncology, January 2019.
