Prostate cancer survivors need not kiss their sex lives goodbye, even if they do not qualify for the least invasive form of a prostatectomy, according to a University of Southern California study.
"Patients who use erection aids after a prostatectomy report levels of sexual functioning that rival those of patients who haven't yet had surgery," said Martin A. Perez, the study's lead author and a USC researcher.
"Not everybody knows that these aids are readily available," said Beth E. Meyerowitz, Ph.D., another USC researcher and a co- author on the study that appears in the November issue of Urology. "This is something that a patient should get information about, but may not be raised in any detail by his doctor."
While rarely fatal, prostate cancer can damage a survivor's quality of life. Up to 90% of patients report impotency or some decrease in sexual functioning following standard radical prostatectomy, past research has shown. The incidence of these side-effects drops to 50% with a relatively new surgical procedure that leaves intact the neurovascural bundles that allow for erections. However, only patients in the early stage of prostate cancer are eligible for so-called nerve-sparing prostatectomies.
Until recently, the main treatment for sexual dysfunction has been surgical implants, which initially inspired complaints but have improved considerably over the past 15 years. Pharmacological approaches have recently become available, with an oral medication to combat impotence expected to hit the market within the coming year. Despite such advances, research has shown that physicians are often reluctant to initiate discussions about sexuality.
"I've had a lot of patients whose doctors have said, 'Look, sexual dysfunction is a side-effect, and you're just going to have to learn to live with it," said Eila C. Skinner, M.D., an associate professor of clinical urology at USC's School of Medicine.
"For many men, erection difficulties cut to the core of male identity, so these problems can represent a significant loss," said Barry Reynolds, Ph.D., a USC psychologist and sex therapist, who also contributed to the study. "Erection difficulties can be equally devastating for the partner not just because of the loss of intercourse, but because of a loss of physical intimacy and emotional closeness."
Perez, Meyerowitz, Skinner, Reynolds and two other USC researchers looked at 294 prostate cancer patients, 45 of whom were awaiting a radical prostatectomy, 117 of whom had undergone a nerve-sparing radical prostatectomy and 132 of whom had undergone a standard prostatectomy. Of the patients who had undergone some form of prostatectomy, 74 used some sort of erection aid, including penile implants, a pharmacoerection program or vacuum constriction devices.
After controlling for age and ability to carry out daily activities, the researchers found no statistically significant differences in the likelihood of being aroused by a partner or the frequency of sexual activity considered by the patients to be ideal, so any differences in performance could not be attributed to differences in sex drives.
In keeping with past research, the USC team found that patients who had undergone nerve-sparing surgery alone reported dramatically higher levels of sexual functioning than the group who had undergone a radical prostatectomy alone.
When compared to the radical prostatectomy group, the nerve-sparing group reported higher levels of desire and sexual activity and greater frequency of orgasms.
But as impressive as the nerve-sparing surgery appeared when compared to a radical prostatectomy, it paled by comparison to erection aids in allowing patients to recover their sex lives.
When asked whether satisfied with their current level of sexual performance, 36% of patients who were using erection aids following a prostatectomy responded affirmatively, versus 14% for the nerve-sparing patients and 8% for the standard prostatectomy patients.
When compared to the nerve-sparing surgery group, the erection-aid group was more likely to report having a "slightly to extremely satisfactory overall sex life" (73% versus 39%), sexual activity at least once a week (55% versus 31%) and orgasms through intercourse at least 50% of the time (89% to 53%).
"People are getting the less invasive surgery in the hope of protecting the quality of their sex lives, but erection aids appear to do just as good a job," said Meyerowitz, an associate professor of psychology who specializes in quality-of-life issues for cancer survivors. "This is the first study to compare nerve-sparing patients and patients who use erection aids in sexual satisfaction and functioning."
The researchers predicted that their findings would offer hope to patients who are not candidates for the less invasive surgery.
"It's not all over if you can't have the nerve-sparing surgery," said Perez, a Ph.D. candidate in psychology. "You can turn to the erection aid as a good alternative."
In fact, the group that used erection aids actually rivaled the group that had not yet undergone surgery in sexual satisfaction and performance on key measures.
When compared to the preoperative group, the erection-aid group was just as likely to report having experienced sexual activity with a partner at least once a week, firm erections, orgasm through intercourse and overall satisfaction with their sex life.
"It's clear from the pattern of results that doctors should seriously and routinely discuss the use of erection aids for patients who are going to undergo prostatectomies," said Dr. Reynolds, who is the director of USC's Human Relations Center, a low-cost mental health clinic run by Ph.D. candidates in psychology.
The other researchers on the study were Gary Lieskovsky, M.D., a USC urologist and holder of USC's Donald G. Skinner Chair in Urology; and Donald G. Skinner, M.D., chairman of the USC School of Medicine's urology department and holder of the Hanson-White Chair in Medical Research. The research was funded in part by the American Cancer Society.
MS.MEYEROWITZ -USC- NOV. 21, 1997
EDITOR: Dr. Meyerowitz is a resident of Venice, Calif.; Dr. Reynolds, of Culver City, Calif.; Dr. Skinner, South Pasadena, Calif.; and Mr. Perez, of Pasadena, Calif.
Journal
Urology