It has been found that patients would trade as much as a 10% or greater advantage in five-year survival to avoid ED following prostate-cancer treatment.21 Men consistently value sexual function almost as much as a positive postoperative prognosis. Providers ought to think about how to better support the information needs of their patients.20 Primary-care clinicians have the ability to intervene and provide much needed information, options, and support to prostate-cancer patients and survivors who face ED.
Patients who forgo treatment
The complex, personal struggle with ED can be difficult for many men to discuss with a clinician. By way of illustration, only 30% of prostate-cancer survivors utilize a treatment for ED.22 Thus, a number of men are left with a life-altering condition that has approved options for management. Reasons for not seeking treatment include embarrassment, financial instability, belief that treatment may be risky or harmful, and threatened masculinity.23 In fact, the most common initial reaction to ED is a sense of emasculation.24
Patients with ED who are not treated or counseled can suffer from relationship issues and depression, leading to decreased desire to correct the problem.24 Of those men who have discussed ED with health-care provider and begun treatment, most had longstanding ED and/or presence of other comorbidities.25 These patients make more health-care visits and may have stronger clinician-patient relationships. The small number of patients seeking treatment management for ED desired to improve their self-esteem, hear about the available therapies, and presented at the insistence of their partner.23 Awareness of the negative beliefs surrounding outcomes of ED helps providers understand the importance of opening a discussion of the condition and the possibility of beginning treatment. Increased quality of life and positive results following treatment can ease patients’ minds and support the choice to initiate therapy.
Nearly 95% of men surveyed said they would be willing to have a one-on-one consultation with a health-care provider concerning ED and its management. However, this was decided only after being approached about the issue.10 Men visit clinicians less frequently than women and will more often play a submissive role in the provider-patient relationship.26 Men are receptive to a discussion of ED, so it must be adequately addressed in the primary-care setting. With informative intervention, positive changes in sexual function and receptiveness to medical or surgical management for ED are achievable.10 Effective treatment of ED after radical prostatectomy will improve a man’s mental and physical quality of life.24
Ms. Daniel is a second-year student in the physician assistant program at the Medical College of Georgia in Augusta, where Ms. Haddow is an assistant professor and director of education.
1. Stanford JL, Feng Z, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA. 2000;283:354-360.
3. Stanford JL, Stephenson RA, Coyle LM, et al. Prostate Cancer Trends 1973-1995. Bethesda, Md: SEER Program, National Cancer Institute; 1999. National Institutes of Health publication 99-4543.
5. Wasson JH, Cushman CC, Bruskewitz RC, et al. A structured literature review of treatment for localized prostate cancer. Prostate Disease Patient Outcome Research Team. Arch Fam Med. 1993;2:487-493.
8. Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight to etiology and prevention. J Urol. 1982;128:492-497.
9. Mulhall JP, Penile rehabilitation following radical prostatectomy. Curr Opin Urol. 2008; 18:613-620.
11. Raina R, Agarwal A, Ausmundson S, et al. Early use of vacuum constriction device following radical prostatectomy facilitates early sexual activity and potentially earlier return of erectile function. Int J Impot Res. 2006;18:77-81.
12. Candy B, Jones L, Williams R, et al. Phosphodiesterase type 5 inhibitors in the management of erectile dysfunction secondary to treatments for prostate cancer: findings from a Cochrane systematic review. BJU Int. 2008;102:426-431.
13. Albaugh JA, Ferrans CE. Impact of penile injections on men with erectile dysfunction after prostatectomy. Urol Nurs. 2010;30:64-77.
14. Burnett AL. Erectile dysfunction following radical prostatectomy. JAMA. 2005;293:2648-2653.
15. Colombo F, Cogni M, Deiana G, et al. [Vacuum therapy]. Arch Ital Urol Nefrol Androl. 1992;64:267-269.
16. Scott FB, Bradley WE, Timm GW. Management of erectile impotence. Use of implantable inflatable prosthesis. Urology. 1973;2:80-82.
17. Sidi AA, Becher EF, Zhang G, Lewis JH. Patient acceptance of and satisfaction with an external negative pressure device for impotence. J Urol. 1990;144:1154-1156.
18. Donatucci CF, Greenfield JM. Recovery of sexual function after prostate cancer treatment. Curr Opin Urol. 2006;16:444-448.
19. Kim ED, Scardino PT, Hampel O, et al. Interposition of sural nerve restores function of cavernous nerves resected during radical prostatectomy. J Urol. 1999;161:188-192.
20. Boberg EW, Gustafson DH, Hawkins RP, et al. Assessing the unmet information, support and care delivery needs of men with prostate cancer. Patient Educ Couns. 2003;49:233-242.
21. Singer PA, Tasch ES, Stocking C, et al. Sex or survival: trade-offs between quality and quantity of life. J Clin Oncol. 1991;9:328-334.
22. Rosen RC, Fisher WA, Eardley I, et al. The multinational Men’s Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin. 2004;20:607-617.
23. Ansong KS, Lewis C, Jenkins P, Bell J. Help-seeking decisions among men with impotence. Urology. 1998;52:834-837.
25. Mirone V, Gentile V, Zizzo G, et al. Did men with erectile dysfunction discuss their condition with partner and physicians? A survey of men attending a free call information service. Int J Impot Res. 2002;14:256-258.
26. Addis ME, Mahalik JR. Men, masculinity, and the contexts of help seeking. Am Psychol. 2003;58:5-14.
All electronic documents accessed February 15, 2011