Patients with prostate cancer suffer significant sexual dysfunction after treatment which negatively affects them and their partners psychologically, and strain their relationships.
We convened an international panel with the aim of developing guidelines that will inform clinicians, patients and partners about the impact of prostate cancer therapies (PCT) on patients' and partners' sexual health, their relationships, and about biopsychosocial rehabilitation in prostate cancer (PC) survivorship.
The guidelines panel included international expert researchers and clinicians, and a guideline methodologist. A systematic review of the literature, using the Ovid MEDLINE, Scopus, CINAHL, PsychINFO, LGBT Life, and Embase databases was conducted (1995-2022) according to the Cochrane Handbook for Systematic Reviews of Interventions. Study selection was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Each statement was assigned an evidence strength (A-C) and a recommendation level (strong, moderate, conditional) based on benefit/risk assessment. Data synthesis included meta-analyses of studies deemed of sufficient quality (3), using A Measurement Tool to Assess Systematic Reviews (AMSTAR).
Guidelines for sexual health care for patients with prostate cancer were developed, based on available evidence and the expertise of the international panel.
The guideline accounts for patients' cultural, ethnic, and racial diversity. It attends to the unique needs of individuals with diverse sexual orientations and gender identities. The guideline is based on literature review, a theoretical model of sexual recovery after PCT, and 6 principles that promote clinician-initiated discussion of realistic expectations of sexual outcomes and mitigation of sexual side-effects through biopsychosocial rehabilitation. Forty-seven statements address the psychosexual, relationship, and functional domains in addition to statements on lifestyle modification, assessment, provider education, and systemic challenges to providing sexual health care in PC survivorship.
The guidelines provide clinicians with a comprehensive approach to sexual health care for patients with prostate cancer.
The strength of the study is the comprehensive evaluation of existing evidence on sexual dysfunction and rehabilitation in prostate cancer that can, along with available expert knowledge, best undergird clinical practice. Limitation is the variation in the evidence supporting interventions and the lack of research on issues facing patients with prostate cancer in low and middle-income countries.
The guidelines document the distressing sexual sequelae of PCT, provides evidence- based recommendations for sexual rehabilitation and outline areas for future research. Wittmann D, Mehta A, McCaughan E, et al. Guidelines for Sexual Health Care for Prostate Cancer Patients: Recommendations of an International Panel. J Sex Med 2022;XX:XXX-XXX.
The journal of sexual medicine. 2022 Sep 30 [Epub ahead of print]
Daniela Wittmann, Akanksha Mehta, Eilis McCaughan, Martha Faraday, Ashley Duby, Andrew Matthew, Luca Incrocci, Arthur Burnett, Christian J Nelson, Stacy Elliott, Bridget F Koontz, Sharon Bober, Deborah McLeod, Paolo Capogrosso, Tet Yap, Celestia Higano, Stacy Loeb, Emily Capellari, Michael Glodé, Heather Goltz, Doug Howell, Michael Kirby, Nelson Bennett, Landon Trost, Phillip Odiyo Ouma, Run Wang, Carolyn Salter, Ted A Skolarus, John McPhail, Susan McPhail, Jan Brandon, Laurel L Northouse, Kellie Paich, Craig E Pollack, Jen Shifferd, Kim Erickson, John P Mulhall
Department of Urology, University of Michigan, Ann Arbor, MI, USA. Electronic address: ., Department of Urology, Emory University, Atlanta, GA, USA., In Memoriam, Ulster University School of Nursing, County Londonderry, Colraine, UK., 4Oaks Consulting, Berryville, VA, USA., Department of Urology, University of Michigan, Ann Arbor, MI, USA., Adult Psychiatry and Health System, Princess Margaret Cancer Center, Toronto, ON, Canada., Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Department of Urology, Johns Hopkins University, Baltimore, MD, USA., Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Departments of Psychiatry and Urologic Sciences, University of British Columbia, Vancouver, BC, Canada., Radiation Oncology, Genesis Care, NC, USA., Department of Psychiatry, Dana Farber Cancer Institute and Harvard University, Boston, MA, USA., School of Nursing, NS Health Authority and Dalhousie University, Halifax, NS, Canada., Department of Urology, Ciircolo & Fondazione Macchi Hospital, University of Insubria, Varese, Lombardy, Italy., Department of Urology, Guys & St Thomas' Hospital, City of London, London, UK., Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada., Department of Urology at NYU Grossman School of Medicine, New York, NY, USA., Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA., Department of Medical Oncology, University of Colorado Cancer Center, Aurora, CO, USA., School of Social Work, University of Houston-Downtown, Houston, TX, USA., Patient with Lived Experience, Keaau, HI, USA., Faculty of the Health and Human Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK., Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Department of Urology, Brigham Young University, Provo, UT, USA; Department of Urology, Mayo Clinic, Rochester, MN, USA., Faraja Cancer Support Trust, Nairobi, Central Province, Kenya., Department of Surgery-Urology, University of Texas McGovern Medical School, Houston, TX, USA; Department of Urology, MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, Madigan Army Medical Center, Tacoma, WA, USA., Department of Urology, University of Michigan, Ann Arbor, MI, USA; VA Health Services Research & Development, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA., Partner with Lived Experience, Okemos, MI, USA., Patient with Lived Experience, Nashville, TN, USA., School of Nursing, University of Michigan, Ann Arbor, MI, USA., Clinical Quality and Survivorship, Movember Foundation, Culver City, CA, USA., Department of Health Policy Management, Johns Hopkins University, Baltimore, MD, USA., Department of Physical Therapy and Rehabilitation Medicine, Michigan Medicine Therapy Services, Ann Arbor, MI, USA., Department of Sexual and Reproductive Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.