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Men retain sexual interest, salvage satisfaction after radical prostatectomy
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Men with prostate cancer who underwent radical prostatectomy remained interested in sex despite functional losses and appeared able to salvage satisfaction, according to results of a retrospective study based on the recently developed Patient-Reported Outcome Measurement Information System.
“Patient-reported outcomes after radical prostatectomy have been widely studied and are a priority in survivorship care, the goal of which is to improve men’s lives after prostate cancer treatment,” Nnenaya Q. Agochukwu, MD, MS, urologist at the Institute for Healthcare Policy & Innovation at University of Michigan, and colleagues wrote. “Sexual dysfunction after radical prostatectomy is directly related to treatment regret, feelings of loss and distress in relationships. The importance of sexuality in prostate cancer is evidenced by the fact that some patients are willing to sacrifice survival to preserve potency.”
Previous studies on patient-reported outcomes after radical prostatectomy have focused primarily on erectile function. The study by Agochukwu and colleagues, however, evaluated single-item measures from subdomains of the Patient-Reported Outcome Measurement Information System (PROMIS).
The analysis included 1,604 men (mean age, 63.2 years; 84.1% white) who underwent robotic radical prostatectomy between May 2014 and January 2016. Most of the men (80.6%) reported being married, whereas 8.2% reported being in a committed relationship and 5.9% reported being single.
The majority of men (80.4%) underwent a bilateral nerve-sparing procedure.
Researchers examined a single item from PROMIS Global Satisfaction with Sex Life that asked, “When you have had sexual activity, how satisfying has it been?” and a single item from PROMIS Interest in Sexual Activity that asked, “How interested have you been in sexual activity?” They also assessed erectile function.
Investigators administered the surveys at baseline before radical prostatectomy and 3, 6, 12 and 24 months after the procedure.
Results showed that the mean PROMIS Interest in Sexual Activity T-score decreased significantly from baseline to 3 months following radical prostatectomy (P = .001), indicating less interest. However, the T-score increased significantly from 3 months to 24 months and exceeded the baseline score after 24 months (P < .001). Overall, T-scores increased by 1.32 (95% CI, 1.04-1.59) points at each follow-up.
The mean PROMIS Global Satisfaction with Sex Life T-score also declined between baseline and 3-month follow-up but increased significantly from 3 months to 24 months (P < .002). Overall, T-scores increased by 1.15 points (95% CI, 0.74-1.56) at each follow-up.
A lack of follow-up beyond 24 months served as the study’s primary limitation.
“Although erectile function is the measure that is more often reported in the literature, this study demonstrates that erectile function is not highly correlated with sexual interest and satisfaction, which supports the need for validated patient-reported measures that comprehensively assess key domains of sexual interest and satisfaction in both research and clinical settings,” Agochukwu and colleagues wrote. “Despite functional losses, interest and satisfaction are dynamic during the recovery period and not completely dependent on erectile function.”
Although the conclusions are sound, the study does not account for men who are gay or those who may not have a willing and able partner, Andrew Vickers, PhD, attending research methodologist at Memorial Sloan Kettering Cancer Center, wrote in an accompanying editorial.
“Gay men have complained to us that the International Index of Erectile Function (IEFF) questions are not appropriate for them,” Vickers wrote. “The IEFF also makes repeated reference to erections, even though that is not a word used in certain groups, such as in parts of the African American community. These sorts of problems also have implications for research.” – by John DeRosier
Disclosures: Agochukwu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Vickers reports consultant/advisory roles with, stock ownership in, and travel expenses from OPKO Health.
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