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Male sexual dysfunction and rehabilitation strategies in the settings of salvage prostate cancer treatment

Abstract

Male sexual dysfunction, a common sequela following primary prostate cancer (PC) treatment, is likely to be more significant following salvage PC therapy. In general, these impairments in sexual domains can be divided into three groups, namely (1) sexual desire, sexuality and masculinity; (2) erectile function (EF); and (3) ejaculation and orgasm. However, there is considerable overlap between these sexual domains and male sexual response cycle, and various factors such as cancer status, mental well-being, medical conditions and social circumstances can adversely impact on the male sexual function. While several preventive and treatment strategies for the preservation and recovery of sexual function are available, there is limited consensus guidelines exist regarding the optimal rehabilitation or treatment protocol for men with sexual dysfunction following salvage therapy. While penile rehabilitation may be effective to restore erectile function and the ability to have coital sex, there is lack of effective treatments in other domains of male sexual function, thereby underscoring the importance of psychological and sexual counselling in sexual rehabilitation. Indeed, a comprehensive multidisciplinary approach is necessary to better understand and optimally assist and manage the men and their respective partners for better sexual health and activity.

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References

  1. 1.

    Crawford-Williams F, March S, Goodwin BC, Ralph N, Galvao DA, Newton RU, et al. Interventions for prostate cancer survivorship: a systematic review of reviews. Psychooncology. 2018;27:2339–48.

    PubMed  Article  PubMed Central  Google Scholar 

  2. 2.

    Calleris G, Marra G, Dalmasso E, Falcone M, Karnes RJ, Morlacco A, et al. Is it worth to perform salvage radical prostatectomy for radio-recurrent prostate cancer? A literature review. World J Urol. 2019;37:1469–83.

    PubMed  Article  PubMed Central  Google Scholar 

  3. 3.

    Pisansky TM, Thompson IM, Valicenti RK, D’Amico AV, Selvarajah S. Adjuvant and salvage radiotherapy after prostatectomy: ASTRO/AUA guideline amendment 2018-2019. J Urol. 2019;202:533–38.

    PubMed  Article  PubMed Central  Google Scholar 

  4. 4.

    Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castrate-resistant prostate cancer. Eur Urol. 2017;71:630–42.

    PubMed  Article  PubMed Central  Google Scholar 

  5. 5.

    Peters M, Moman MR, van der Poel HG, Vergunst H, de Jong IJ, Vijverberg PL, et al. Patterns of outcome and toxicity after salvage prostatectomy, salvage cryosurgery and salvage brachytherapy for prostate cancer recurrences after radiation therapy: a multi-center experience and literature review. World J Urol. 2013;31:403–9.

    PubMed  Article  PubMed Central  Google Scholar 

  6. 6.

    Cuevas AG, Trudel-Fitzgerald C, Cofie L, Zaitsu M, Allen J, Williams R. Placing prostate cancer disparities within a psychosocial context: challenges and opportunities for future research. Cancer Causes Control. 2019;30:443–56.

    PubMed  PubMed Central  Article  Google Scholar 

  7. 7.

    Chung E, Brock G. Sexual rehabilitation and cancer survivorship: a state of art review of current literature and management strategies in male sexual dysfunction among prostate cancer survivors. J Sex Med. 2013;10(Suppl 1):102–11.

    PubMed  Article  PubMed Central  Google Scholar 

  8. 8.

    Nicolosi A, Moreira ED Jr, Villa M, Glasser DB. A population study of the association between sexual function, sexual satisfaction and depressive symptoms in men. J Affect Disord. 2004;82:235–43.

    PubMed  Article  PubMed Central  Google Scholar 

  9. 9.

    Salonia A, Burnett AL, Graefen M, Hatzimouratidis K, Montorsi F, Mulhall JP, et al. Preservation and management of postprostatectomy sexual dysfunctions Part 2: recovery and preservation of erectile function, sexual desire, and orgasmic function. Eur Urol. 2012;62:273–86.

    PubMed  Article  PubMed Central  Google Scholar 

  10. 10.

    Sadovsky R, Basson R, Krychman M, Morales AM, Schover L, Wang R, et al. Cancer and sexual problems. J Sex Med. 2010;7:349–73.

    PubMed  Article  PubMed Central  Google Scholar 

  11. 11.

    Chambers SK, Chung E, Wittert G, Hyde MK. Erectile dysfunction, masculinity, and psychosocial outcomes: a review of the experiences of men after prostate cancer treatment. Transl Androl Urol. 2017;6:60–8.

    PubMed  PubMed Central  Article  Google Scholar 

  12. 12.

    Jackson SE, Wardle J, Steptoe A, Fisher A. Sexuality after a cancer diagnosis: a population-based study. Cancer. 2016;122:3883–91.

    PubMed  PubMed Central  Article  Google Scholar 

  13. 13.

    Bisson JI, Chubb HL, Benneyy S, Mason M, Jones D, Kynaston H. The prevalence and predictors of psychological distress in patients with early localized prostate cancer. BJU Int. 2002;90:56–61.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  14. 14.

    Perlmutter MA, Lepor H. Androgen deprivation therapy in the treatment of advanced prostate cancer. Rev Urol. 2007;9 Suppl 1:S3–8.

  15. 15.

    Tran C, Ouk S, Clegg NJ, Chen Y, Watson PA, Arora V, et al. Development of a second-generation antiandrogen for treatment of advanced prostate cancer. Science. 2009;324:787–90.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  16. 16.

    Sharifi N, Gulley JL, Dahut WL. Androgen deprivation therapy for prostate cancer. JAMA. 2005;294:238–44.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  17. 17.

    Chung E. Management of treatment-related sexual complications in cancer care: evidence for erectile function recovery and penile rehabilitation after radical prostatectomy in prostate cancer survivorship. Expert Rev Qual Life Cancer Care. 2017;2:279–86.

    Article  Google Scholar 

  18. 18.

    Herrera-Caceres JO, Nason GJ, Salgado-Sanmamed N, Goldberg H, Woon DTS, Chandrasekar T, et al. Salvage radical prostatectomy following focal therapy: functional and oncological outcomes. BJU Int. 2020;125:525–30.

    PubMed  Article  PubMed Central  Google Scholar 

  19. 19.

    Chen C, Chen Z, Wang K, Hu L, Xu R, He Z. Comparisons of health-related quality of life among surgery and radiotherapy for localised prostate cancer: a systematic review and meta-analysis. Oncotarget. 2017;8:99057–65.

    PubMed  PubMed Central  Article  Google Scholar 

  20. 20.

    Mazzola CR, Mulhall JP. Impact of androgen deprivation therapy on sexual function. Asian J Androl. 2012;14:198–203.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  21. 21.

    Rosoff JS, Savage SJ, Prasad SM. Salvage radical prostatectomy as management of locally recurrent prostate cancer: outcomes and complications. World J Urol. 2013;31:1347–52.

    PubMed  Article  PubMed Central  Google Scholar 

  22. 22.

    Yuh B, Ruel N, Muldrew S, Mejia R, Novara G, Kawachi M, et al. Complications and outcomes of salvage robot-assisted radical prostatectomy: a single-institution experience. BJU Int. 2014;113:769–76.

    PubMed  Article  PubMed Central  Google Scholar 

  23. 23.

    Chade DC, Eastham J, Graefen M, Hu JC, Karnes J, Klotz L, et al. Cancer control and functional outcomes of salvage radical prostatectomy for radiation-recurrent prostate cancer: a systematic review of the literature. Eur Urol. 2012;61:961–71.

    PubMed  Article  PubMed Central  Google Scholar 

  24. 24.

    Wortel RC, Incrocci L, Mulhall JP. Reporting erectile function outcomes after radiation therapy for prostate cancer: challenges in data interpretation. J Sex Med. 2017;14:1260–9.

    PubMed  Article  PubMed Central  Google Scholar 

  25. 25.

    Nolan MW, Marolf AJ, Ehrhart EJ, Rao S, Kraft SL, Engel S, et al. Pudendal nerve and internal pudendal artery damage may contribute to radiation-induced erectile dysfunction. Int J Radiat Oncol Biol Phys. 2015;91:796–806.

    PubMed  Article  PubMed Central  Google Scholar 

  26. 26.

    Rivin del Campo E, Thomas K, Weinberg V, Roach M 3rd. Erectile dysfunction after radiotherapy for prostate cancer: a model assessing the conflicting literature on dose-volume effects. Int J Impot Res. 2013;25:161–5.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  27. 27.

    Roach M 3rd, Nam J, Gagliardi G, El Naqa I, Deasy JO, Marks LB. Radiation dose–volume effects and the penile bulb. Int J Radiat Oncol Biol Phys. 2010;76:S130–4.

    PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    Wang Y, Liu T, Rossi PJ, Watkins-Bruner D, Hsiao W, Cooper S, et al. Influence of vascular comorbidities and race on erectile dysfunction after prostate cancer radiotherapy. J Sex Med. 2013;10:2108–14.

    PubMed  PubMed Central  Article  Google Scholar 

  29. 29.

    Chung E, Gillman M. Prostate cancer survivorship: a review of erectile dysfunction and penile rehabilitation after prostate cancer therapy. Med J Aust. 2014;200:582–5.

    PubMed  Article  PubMed Central  Google Scholar 

  30. 30.

    Snyder KM, Stock RG, Buckstein M, Stone NN. Long-term potency preservation following brachytherapy for prostate cancer. BJU Int. 2012;110:221–5.

    PubMed  Article  PubMed Central  Google Scholar 

  31. 31.

    Rana Z, Hong RL, Abugideiri M, McRae D, Cernica G, Mordkin R, et al. Sexual, irritative, and voiding outcomes, following stereotactic body radiation therapy for prostate cancer. Radiat Oncol. 2015;10:182.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  32. 32.

    Smit Duijzentkunst DA, Peters M, van der Voort van Zyp JRN, Moerland MA, van Vulpen M. Focal salvage therapy for local prostate cancer recurrences after primary radiotherapy: a comprehensive review. World J Urol. 2016;34:1521–31.

    Article  CAS  Google Scholar 

  33. 33.

    de Castro Abreu AL, Bahn D, Leslie S, Shoji S, Silverman P, Desai MM, et al. Salvage focal and salvage total cryoablation for locally recurrent prostate cancer after primary radiation therapy. BJU Int. 2013;112:298–307.

    PubMed  Article  PubMed Central  Google Scholar 

  34. 34.

    Baco E, Gelet A, Crouzet S, Rud E, Rouviere O, Tonoli-Catez H, et al. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. BJU Int. 2014;114:532–40.

    PubMed  Article  PubMed Central  Google Scholar 

  35. 35.

    Shawn D, Nathan CW, Christopher BA, Jen H, William O, Bobby S. High-intensity focused ultrasound (HIFU) as salvage therapy for radio-recurrent prostate cancer: predictors of disease response. Int Braz J Urol. 2018;44:248–57.

    Article  Google Scholar 

  36. 36.

    Ismail M, Ahmed S, Kastner C, Davies J. Salvage cryotherapy for recurrent prostate cancer after radiation failure: a prospective case series of the first 100 patients. BJU Int. 2007;100:760–4.

    PubMed  Article  PubMed Central  Google Scholar 

  37. 37.

    Rowland D, McMahon CG, Abdo C, Chen J, Jannini E, Waldinger MD, et al. Disorders of orgasm and ejaculation in men. J Sex Med. 2010;7:149–55.

    Article  Google Scholar 

  38. 38.

    Barnas JL, Pierpaoli S, Ladd P, Valenzuela R, Aviv N, Parker M, et al. The prevalence and nature of orgasmic dysfunction after radical prostatectomy. BJU Int. 2004;94:603–5.

    PubMed  Article  PubMed Central  Google Scholar 

  39. 39.

    Helgason AR, Fredrikson M, Adolfsson J, Steineck G. Decreased sexual capacity after n radiation therapy for prostate cancer impairs quality of life. Int J Radiat Oncol Biol Phys. 1995;32:33–9.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  40. 40.

    Incrocci L, Slob A, Levendag PC. Sexual (dys)function after radiotherapy for prostate cancer: a review. Int J Radiat Oncol Biol Phys. 2002;52:681–93.

    PubMed  Article  PubMed Central  Google Scholar 

  41. 41.

    Clavell-Hernández J, Martin C, Wang R. Orgasmic dysfunction following radical prostatectomy: review of current literature. Sex Med Rev. 2018;6:124–34.

    PubMed  Article  PubMed Central  Google Scholar 

  42. 42.

    Frey AU, Sønksen J, Fode M. Neglected side effects after radical prostatectomy: a systematic review. J Sex Med. 2014;11:374–85.

    PubMed  Article  PubMed Central  Google Scholar 

  43. 43.

    Messaoudi R, Menard J, Ripert T, Staerman F. Erectile dysfunction and sexual health after radical prostatectomy: impact of sexual motivation. Int J Impot Res. 2011;23:81–6.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  44. 44.

    Higano CS. Side effects of androgen deprivation therapy: monitoring and minimizing toxicity. Urology. 2003;61:32–8.

    PubMed  Article  PubMed Central  Google Scholar 

  45. 45.

    Nguyen TM, Pastuszak AW. Testosterone therapy among prostate cancer survivors. Sex Med Rev. 2016;4:376–88.

    PubMed  PubMed Central  Article  Google Scholar 

  46. 46.

    Mahal BA, Chen MH, Bennett CL, Kattan MW, Sartor O, Stein K, et al. High PSA anxiety and low health literacy skills: drivers of early use of salvage ADT among men with biochemically recurrent prostate cancer after radiotherapy? Ann Oncol. 2015;26:1390–95.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  47. 47.

    Chambers SK, Occhipinti S, Schover L, Nielsen L, Zajdlewics L, Clutton S, et al. A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Psychooncology. 2015;24:748–56.

    PubMed  Article  PubMed Central  Google Scholar 

  48. 48.

    Li M, Chan CWH, Chow KM, Xiao J, Choi KC. A systematic review and meta-analysis of couple-based intervention on sexuality and the quality of life of cancer patients and their partners. Support Care Cancer. 2020;28:1607–30.

    PubMed  Article  PubMed Central  Google Scholar 

  49. 49.

    Maliski SL, Connor S, Fink A, Litwin MS. Information desired and acquired by men with prostate cancer: data from ethnic focus groups. Health Educ Behav. 2006;33:393–409.

    PubMed  Article  PubMed Central  Google Scholar 

  50. 50.

    Padma-Nathan H, McCullough AR, Levine LA, Lipshultz LI, Siegel F, Montorsi F, et al. Randomized, double-blind, placebo-controlled study of post-operative nightly sildenafil citrate for prevention of erectile dysfunction after bilateral nerve-sparing radical prostatectomy. Int J Impot Res. 2008;20:479–86.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  51. 51.

    Montorsi F, Brock G, Lee J, Shapiro J, van Poppel H, Graefen M, et al. Effect of nightly versus on-demand vardenafil no recovery of erectile function in men following bilateral nerve-sparing radical prostatectomy. Eur Urol. 2008;54:924–31.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  52. 52.

    Montorsi F, Brock G, Stolzenburg JU, Mulhall J, Moncada I, Patel HRH, et al. Effects of tadalafil treatment on erectile function recovery following bilateral nerve-sparing radical prostatectomy: a randomized placebo-controlled study (REACTT). Eur Urol. 2014;65:587–96.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  53. 53.

    Martin C, Nolen H, Podolnick J, Wang R. Current and emerging therapies in premature ejaculation: where we are coming from, where we are going. Int J Urol. 2016;24:40–50.

    PubMed  Article  PubMed Central  Google Scholar 

  54. 54.

    Campbell JD, Burnett AL. Neuroprotective and nerve regenerative approaches for treatment of erectile dysfunction after cavernous nerve injury. Int J Mol Sci. 2017;18:1794.

    PubMed Central  Article  CAS  Google Scholar 

  55. 55.

    Baccaglini W, Pazeto CL, Corrêa Barros EA, Timoteo F, Monteiro L, Rached RYS, et al. The role of the low-intensity extracorporeal shockwave therapy on penile rehabilitation after radical prostatectomy: a randomized clinical trial. J Sex Med. 2020;17:688–94.

    PubMed  Article  CAS  PubMed Central  Google Scholar 

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Correspondence to Eric Chung.

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Chung, E. Male sexual dysfunction and rehabilitation strategies in the settings of salvage prostate cancer treatment. Int J Impot Res (2021). https://doi.org/10.1038/s41443-021-00437-4

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