PCa SIG: Improving sexual health before and after prostate cancer

The session kicked off with a lecture from EAUN chair Ms. Corinne Tillier (NL), who spoke about the research from her PhD topic on non-surgical predictive factors of erectile function recovery after robotic assisted radical prostatectomy (RARP). Erectile dysfunction in the general population was found to increase with age, co-morbidity, smoking and alcohol consumption and may be the result of certain medications. Her presentation highlighted that erectile function after RARP is multi-factorial and depends on several factors such as age, function prior to the procedure and the surgical technique, for example, if nerve spare was performed. Ms. Tillier’s research showed that erectile function recovery after RARP could be a lengthy process taking up to three years, and physical activity more than once a week was an independent predictor of erectile function recovery one year post RARP. Therefore, physical activity programmes can aid in the recovery of erectile function after RARP.

Following this, physiotherapist and PhD student Ms. Malene Blumenau Pedersen (DK) discussed the principles behind surgical prehabilitation for sexual health and presented her own experience of sexual health interventions for patients about to undergo a prostatectomy by trying to enhance function prior to surgery and so improve outcomes and reduce complications. Most prehabilitation studies tend to focus on single interventions whilst Ms. Blumenau Pedersen’s project examined if a multi-modal four-week prehabilitation programme was feasible, consisting of five interventions: physical exercise, pelvic floor exercises, sexual health (having a video consultation with a clinic sexologist), nutritional advice, and stress management.

The preliminary results have shown that there are variations in patient experiences regarding the importance of sexual health interventions and that an individualised, patient-centred holistic approach is crucial to understanding the diverse needs and preferences of the patient. Further research is required to understand the full impact of prehabilitation for sexual health prior to prostatectomy.

Therapeutic radiographer Mr. Phil Reynolds (GB) presented on the topic of “loss of libido due to prostate cancer treatment and how this can be managed”. His talked outlined how a cancer diagnosis can cause psychological problems such as a loss in confidence, a fear of rejection and feeling like less of a “man”. He highlighted that a lot of the focus is on treating the erectile dysfunction with little done about libido itself despite patient reported outcomes defining it as a big problem. Although libido can be difficult to treat, it is important to focus on bother over function and ensure that partners are included in any discussions. It is essential to listen to their needs, but most importantly, make sure that expectations are managed and not unrealistic. The presentation also emphasised that it is important to take the focus off orgasm and to find non-sexual ways of staying close but also to try sensate focused exercises to increase the awareness of both the patient’s and partner’s body. The presentation included resources such as referring patients to www.lifeonADT.com, which is an educational programme for patients and partners to learn about the side effects of ADT and how best to manage them.

Lastly, urologist Dr. Findlay MacAskill (GB) spoke about supporting gay and bisexual men (GBM) with prostate cancer. The presentation highlighted that the effects of treatment of erectile tissues in heterosexuals is well documented but there is limited information for sexual minorities and that sexuality should not be a barrier to sexual support. Clinicians seem to think that there is no problem, and they treat everyone the same with open discussions, but evidence suggests that there is a mismatch in doctor/patient views with many GBM not being asked about their sexuality and that erectile function questionnaires are validated on heterosexual couples. Hopefully this is changing with the development by the University of Minnesota of a new PROM: The Sexual Minority and Prostate Cancer Scale (SMACS) created with 401 GBM, which can be used by clinicians to comprehensively measure sexual functioning in sexual minority men in conjunction with existing scales. Ultimately, the only way change is going to happen and the take home message from the presentation, is to ensure you ASK about sexuality, so the conversation is appropriate to the patient.

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By Mr. Phil Reynolds (GB)