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Future directions in improving sexual function for prostate cancer patients

International Journal of Impotence Research volume 33, pages 497–498 (2021)Cite this article

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When considering future directions in improving sexual function for prostate cancer patients, it’s easy to get lost in dreams about regenerative medicine and to look for one tool to fix all problems. Low intensity extracorporal shock wave therapy (Li-ESWT) and stem cells have been the subject of the majority of studies, with platelet rich plasma injections representing a third option. However, as we’ve seen in the paper by Lund et al., the data in this area are very preliminary and almost exclusively include animal studies and safety data in humans [1]. Among the few clinical trials, the data has not convincingly shown improvements in erectile function at or above the established minimal clinically significant difference. Thus, the most positive predicate the area can receive at the moment is that it is “promising” and regenerative medicine for restoration of sexual function following prostate cancer treatments is unlikely to reach the clinic in any foreseeable future. Meanwhile, it may be reasonable to focus on much simpler avenues for supporting and improving sexual function in our patients.

The first solution is technically unrelated to sexual medicine and include reducing the degree of physical disruption caused by the treatments. In this regard, we need exhaustive methods to safely select patients for active surveillance and to implement this management strategy whenever possible. For patients needing treatment for localized cancer, radiation therapy and radical prostatectomy currently represents the well-established modalities. While considered equivalent regarding oncological outcomes, the treatments may have quite different effects on sexual function [2,3,4]. As highlighted several times in this special issue, more research using standardized methods of evaluating a broad spectrum of these side-effects and the bother they induce are needed. This is important because it plays a role in patient counseling and selection of treatments. In this regard, most focus so far has been on erectile function and vaginal intercourse. This misses the fact that sexuality is very individual and it neglects the situation for non-heterosexual and transgender prostate cancer survivors. As concrete examples, it can be considered that climacturia will have very different implications for couples who practice oral sex and those who do not and that rectal irritation from radiation may be highly problematic in men who are the receiving part of anal intercourse, while it will have limited sexual consequences for those who are not. Limitations in our knowledge about sexual problems following treatment in MSM are described in the paper by Martin-Tuite and Shindel [5]. As highlighted, this is a non-negligible minority and more specific studies—both qualitative and quantitative—should be conducted.

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References

  1. Lund L. Role of regenerative therapies on post prostatectomy erectile dysfunction. Int J Impot Res. 2020; in press.

  2. Ramasamy R, Lima TFN, Joshua B, Frech FS. Prevalence of post-prostatectomy erectile dysfunction and a review of the recommended therapeutic modalities. Int J Impot Res. 2020; in press.

  3. Nguyen D-D, Berlin A, Matthew AG, Perlis N, Elterman DS. Sexual function and rehabilitation after radiation therapy for prostate cancer: a review. Int J Impot Res. 2020; in press.

  4. Nolsøe AB, Jensen CFS, Østergren PB, Fode M. Neglected side effects to curative prostate cancer treatments. Int J Impot Res. 2020; in press.

  5. Martin-Tuite P, Shindel A. Prostate cancer and sexual consequences among MSM. Int J Impot Res. 2020; in press.

  6. Fallara G, Capogrosso P, Maggio P, Taborelli A, Montorsi F, Dehò F et al. Erectile function after focal therapy for localized prostate cancer: a systematic review. Int J Impot Res. 2020; in press.

  7. Vanderhaeghe D, Albersen M, Weyne E. Focusing on sexual rehabilitation besides penile rehabilitation following radical prostatectomy is important. Int J Impot Res. 2020; in press.

  8. Choi EJ, Xu P, El-Khatib FM, Yafi F. Hypogonadism and its treatment among prostate cancer survivors. Int J Impot Res. 2020; in press.

  9. Corona G, Filippi S, Comelio P, Bianchi N, Frizza F, Dicuio M et al. Sexual function in men undergoing androgen deprivation therapy. Int J Impot Res. 2020; in press.

  10. Walker LM. Psychosocial contributors to patients’ and partners’ post-prostate cancer sexual recovery: evidence-based and practical considerations. Int J Impot Res. 2020; in press.

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  1. Department of Urology, Zealand University Hospital, Roskilde, Denmark

    Mikkel Fode

  2. Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark

    Mikkel Fode

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Correspondence to Mikkel Fode.

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MF is a speaker for Astellas Pharma and an advisor for Ferring Pharmaceuticals.

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Fode, M. Future directions in improving sexual function for prostate cancer patients. Int J Impot Res 33, 497–498 (2021). https://doi.org/10.1038/s41443-020-00391-7

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