Men's Sexual Help-Seeking and Care Needs After Radical Prostatectomy or Other Non-Hormonal, Active Prostate Cancer Treatments - Beyond the Abstract

Sexual difficulties are one of the most common, distressing, and persistent treatment-related challenges for men diagnosed with prostate cancer, often under-recognized and poorly managed. Many men who have received prostate cancer treatment have unmet sexual care needs that remain over time, with these needs further exacerbated by men’s reluctance to seek help for their sexual concerns. We explored this reluctance by surveying men diagnosed with prostate cancer who received an active treatment (radical prostatectomy or other non-hormonal treatment) at two time points and asked them about their sexual help-seeking intentions and behaviors, and unmet sexual care needs.

The goal of this research was to identify contributors to prostate cancer survivors' unmet sexual care needs and to their decisions to seek help for these needs. Of particular interest were those contributors that might be potentially modifiable to encourage more prostate cancer survivors to engage with primary and specialist health care providers about their sexual difficulties.

We found that two-thirds of men had one or more unmet sexual care needs, most commonly related to changes in sexual feelings and sexual relationships. Over 70% of men still had these unmet sexual care needs at a six-month follow-up. Poorer erectile function, being unsatisfied with their sex life, valuing sex as important and key to their identity (masculine values), and depression was associated with prostate cancer survivors having greater sexual care needs.

In this study, prostate cancer survivors most often intended to seek help from a doctor, and this was also the most commonly reported form of sexual help-seeking at follow-up. Sexual therapists were least often sought out for help.

Prostate cancer survivors were more likely to seek help for their sexual difficulties if they felt confident to do so, believed their partner or other people they valued would support them, viewed sexual help-seeking as a positive action, and valued sex as an important part of their identity. Having sought help for sexual concerns at follow-up was linked to having intended (planned) to seek help, and feeling generally anxious. Men who sought sexual help in the past had higher levels of both intended and actual sexual help-seeking.

Going forward, building prostate cancer survivors' sense of confidence and capabilities to seek help for their sexual difficulties should be a central goal for practitioners. This goal could be achieved first by normalizing their experience and then making men aware of the range of support available to them. Methods to improve or ease access to support by online or telehealth delivery are also likely important. Delivering support remotely not only increases accessibility, but it is also more convenient and makes it possible for men to retain a sense of anonymity so they may feel more comfortable to express concerns that might be difficult to discuss in face-to-face interactions.  

Distress was a contributor to both unmet sexual care needs and sexual help-seeking. Screening for distress is now an accepted component of oncology care and is crucial for men with prostate cancer who may be reluctant to self-disclose their distress.1 Given many men experience long-term psychological distress after prostate cancer,2 attention to this aspect of care is critical.

Masculine values influence men’s experience of and responses to prostate cancer treatment, and in this study, also contributed to their unmet sexual care needs and intended help-seeking. Sexual care interventions should include acknowledgment of masculine values in a men-centered approach and exercises or activities are needed that assist men to reframe seeking help for their sexual difficulties as an act consistent with values around self-reliance and personal agency. In this regard, the Prostate Cancer Essentials Survivorship Framework identified six domains that were essential for quality survivorship care: Health Promotion and Advocacy; Shared Management; Vigilance; Personal Agency; Care Coordination and Evidence-based Survivorship Interventions.3 Each of these domains provides guidance as to how supportive interventions might be holistically delivered to better connect with the needs and preferences of the man and his partner in a way that improves both acceptability and effectiveness.

Prostate cancer survivors had persistent unmet needs suggesting that they require specialized assistance. Psychosocial providers, including sexual therapists, prostate cancer nurses, peer support communities, and psychologists are ideally placed to support and address the sexual health care needs and concerns of these men. Yet, few men sought help from these sources, instead preferring their primary care provider (doctor). Initiatives that better link and integrate services offered by primary care and specialized psychosocial practitioners, as well as community supports, are needed to support men in their life after prostate cancer diagnosis and treatment.

Written by: Melissa K. Hyde, PhD, Twitter: @DrMelHyde1 and Suzanne K. Chambers, PhD, Twitter: @ChambersinOz2,3,4,5

  1. School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
  2. University of Technology Sydney, Sydney, New South Wales, Australia
  3. Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
  4. Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
  5. Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia

  1. Dunn, Jeff, and Suzanne K. Chambers. "‘Feelings, and feelings, and feelings. Let me try thinking instead’: Screening for distress and referral to psychosocial care for men with prostate cancer." European journal of cancer care (2019).
  2. Occhipinti, Stefano, Leah Zajdlewicz, Geoffrey D. Coughlin, John W. Yaxley, Nigel Dunglison, Robert A. Gardiner, and Suzanne K. Chambers. "A prospective study of psychological distress after prostate cancer surgery." Psycho‐oncology 28, no. 12 (2019): 2389-2395.
  3. Dunn, Jeff, Anna Green, Nicholas Ralph, Robert U. Newton, Andrew Kneebone, Mark Frydenberg, and Suzanne K. Chambers. "Prostate cancer survivorship essentials framework: guidelines for practitioners." BJU international (2020).
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