Sexual Function Issues. Among Men With Prostate Cancer Fiona Newton. Research Team . PhD Candidate Fiona Newton, BSc. Hons. Research Supervisors Dr. Sue Burney, Ph.D., MAPS. Registered Psychologist. Director, External Programs and Lecturer, Department of Psychology School of
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Among Men With Prostate Cancer
Fiona Newton, BSc. Hons.
Dr. Sue Burney, Ph.D., MAPS. Registered Psychologist.
Director, External Programs and Lecturer, Department of Psychology School of
Psychology, Psychiatry and Psychological Medicine, Faculty of Medicine,
Nursing and Health Sciences Monash University.
Associate Professor Mark Frydenberg, MBBS, FRACS.
Clinical Associate Professor, Department of Surgery, Monash University;
Chairman, Department of Urology, Monash Medical Centre.
Dr. Jeremy Millar, FRANZCR, FAChPM.
Radiation Oncologist, The William Buckland Radiotherapy Clinic.
Professor Kim Ng, Ph.D.
Head, School of Psychology, Psychiatry and Psychological Medicine, Faculty of
Medicine, Nursing and Health Sciences, Monash University.
Faculty of Medicine, Nursing and Health Sciences,
Department of Psychology
Australian Mortality Data
*Second only to lung cancer related deaths
(Australian Institute of Health and Welfare, [AIHW] & Australasian
Association of Cancer [AACR], 2003).
Impact of Age
e.g. American males between 40 – 59 years: 1 in 45
(American Cancer Society [ACS], 2003).
nerve sparing / non-nerve sparing
EBRT / Brachytherapy
PSA and DRE
Sexual Arousal + Erect Penis in potent males
Orgasm and Ejaculation
(Seidman & Roose, 2000)
Male Sexual Dysfunction
(Brucker & Cella, 2003; National Institute of Health [NIH], 1993)
(American Psychiatric Association, 1994; Incrocci et al., 2002; Schover, Friedman,
Weiler, Heiman, & LoPiccolo, 1982)
An inability to attain and sustain a penile erection that is
adequate for ‘satisfactory’ sexual intercourse.
(1993 National Institutes of Health consensus on erectile dysfunction)
Limitations of Definition
Fails to address the issue of erectile function problems
among men without a willing sexual partner
Need a broader definition that encapsulates the quality of the
erection outside the context of sexual intercourse.
(Incrocci et al., 2002)
The inability of the male to obtain and maintain a rigid penis
long enough for sexual performance
(Incrocci et al., 2002; Katz et al., 2002).
affected across all treatment intervention in both the short and
(Brucker & Cella, 2003; Litwin, Flanders, Pasta, Stoddard, et al.,1999)
(De Berardis et al., 2002; Feldman, Goldstein, Hatzichriou, Krane, & McKinlay,
1994; Huges, 2000; Ofman, 1995)
many of the physiological side-effects of cancer treatment
(e.g. nausea, fatigue, and bodily pain) have resolved.
(Braslis et al., 1995, Helgason, Adolfsoon, et al., 1997; Litwin, Hays, et al., 1995)
treatment modality during the first two yearsafter treatment
dissatisfied with residual decrements in their sexual
men in deciding which therapeutic intervention to undertake.
(Hall, Boyd, Lippert, & Theodorescu, 2003; Schover et al., 2002; Porterfield, 1997;
Singer et al., 1991)
N = 1,236 men treated for localised prostate cancer
Treatments: definitive radiation therapy or prostatectomy
Average time since treatment: 4.3 years
Findings Pertaining to Treatment Choice
had influenced their choice of treatment to some degree
was a major issue in treatment choice
was a minor consideration
Findings Pertaining to Sexual Function
The greater majority of patients who underwent either
radiation therapy or prostatectomy still suffered from sexual
dysfunction and remained dissatisfied with their sexual
functioning more than four years after treatment.
(Incrocci et al. 2002)
Common Male Attitudes Towards Their Health
Note: Taken from Bruckenwell, P., Jackson, D., Luck, M., Wallace, J., & Watts, J. (1995). The crisis in men’s health. Bath, UK: Community Health UK.
Sexual Function among Men Treated for Localised Prostatic Cancer: A Retrospective Australian Pilot Study
(Newton, F., Burney, S., Frydenberg, M., Millar, J., & Ng, K. T.)
To investigate whether sexual, urinary, and bowel dysfunction
influenced the HRQOL of men treated for localised prostate
cancer two or more years prior to the study.
Note: Only the descriptive data pertaining to sexual function is
presented in this seminar.
HRQOL Measures Used
Participants also completed a study specific ‘Demographic &
Brief Medical’ questionnaire
Prostate Cancer Participants
two years previously
Non-Prostate Cancer Participants
-ve Prostate Specific Antigen blood test
-ve Digital Rectal Exam
Participant scores on the UCLA-PCI sexual and bother scales
were categorised using clinical criteria such that:
(i.e. high levels of sexual function or low level of sexual bother)
(i.e. low levels of sexual function or high level of sexual bother)
Only 25.7% (n = 48) of prostate cancer patients reported
using erectile aids.
This finding seems counter-intuitive given the high levels of
sexual dysfunction noted among the same patient cohort.
We are investigating this issue in a prospective study that is
currently underway in Melbourne.
Unfortunately, data pertaining to the usage of sexual function
aids were not collected from participants in the comparison
Sexual Function Problems
Among Men With and Without a Diagnosis of
Localised Prostate Cancer
PhD Research Project
erectile dysfunction on men undergoing brachytherapy or a
prostatectomy for localised prostate cancer.
partners of patients toward erectile dysfunction and the use
of erectile aids
A prospective longitudinal study to assess the relationship
between male participant’s sexual functioning ability and
selected dimensions of their HRQOL.
functioning of brachytherapy and prostatectomy patients and
specific dimensions of their health-related quality of life.
problems experienced by patients with erectile dysfunction.
Spouses / Partners of Male Participants
Prostate Cancer Specialists:
Study Specific Measures
Spouse / Partner Measures
Prostate Cancer Specialist Measure
interview (administered once)
It is anticipated that the findings will:
support for patients during the treatment selection and the
post-treatment recovery phases.
about the possible psychosocial sequale associated with
American Cancer Society. (2003). Cancer Facts & Figures 2003. http://www.cancer.org/downloads/STT/CAFF2003PWSecured. pdf. Accessed January 15, 2004.
American Psychiatric Association. (1994). Diagnostic and statistical manual for mental disorders (4th ed.). Washington, DC: Author.
Australian Institute of Health and Welfare [AIHW] & Australasian Association of Cancer [AACR]. (2003). Cancer in Australia 2000.
http:// ww.aihw.gov.au/publications/can/ca00/ca00-x03.pdf. Accessed 15th January, 2004.
Braslis, K., Snata-Cruz, C., Brickman, A., Soloway, M. S. (1995). Quality of life 12 months after radical prostatectomy. British Journal of Urology, 75, 48-53.
Bruckenwell, P., Jackson, D., Luck, M., Wallace, J., & Watts, J. (1995). The crisis in men’s health. Bath, UK: Community Health UK.
Brucker, P. S., & Cella, D. (2003). Measuring self-reported sexual function in men with prostate cancer. Urology, 62, 596-606.
De Berardis, G., Franciosi, M., Belfiglio, M., Di Nardo, B., Greenfield, S., Kaplan, S., Valentini, M., & Nicolucci, A. (2002). Erectile dysfunction and quality of life in type 2 diabetic patients: A serious problem too often overlooked. Diabetics Care, 25(2), 284-291.
Hall, J. D., Boyd, J. C., Lippert, M. C., & Theodorescu, D. (2003). Why patients choose prostatectomy or brachytherapy for localized prostate cancer: Results of a descriptive study. Urology, 61, 402-407.
Helgason, A. R., Adolfsoon, J., Dickman, P., Arver, S., Fredrikson, M., & Steinbeck, G. (1997). Factors associated with waning sexual function among elderly men and prostate cancer patients. Journal of Urology, 158, 155-159.
Huges, M. K. (2000). Sexuality and the cancer survivor: A silent coexistence. Cancer Nursing, 23(6), 477-482.
Incrocci, L., Slob, A. K., & Levendag, P. C. (2002). Sexual (dys)function after radiotherapy for prostate cancer: A review. Int. J. Radiation Oncology Biol. Phys, 52(3), 681-693.
Katz, R., Salomon, L., Hoznek, A., De La Taille, A., Vordos, D., Cicco, A., Chopin, D., & Abbou, C. C. (2002). Patient reported sexual function following laparoscopic radical prostatectomy. Journal of Urology, 168, 2078-2082.
Litwin, M. S., Hays, R. D., Fink, A., Ganz, P. A., Leake, B., Leach, G. E., & Brook, R. H. (1995). Quality-of-life outcomes in men treated for localized prostate cancer. JAMA, 273(2), 129-135.
National Institute of Health [NIH]. (1993). National Institute of Health consensus conference. Impotence. JAMA, 270(1), 83-90.
Ofman, U. S. (1995). Sexual quality of life in men with prostate cancer. Cancer, 75, 1949-1953. Retrieved July 20, 2002 from Wiley Interscience database.
Porterfield, H.A. (1997). Perspectives on prostate cancer treatment: Awareness, attitudes, and relationships. Urology, 49(supplement 3A), 102-103.
Schover, L. R., Fouladi, R. T., Warneke, C. L., Neese, L., Klein, E. A., Zippe, C., & Kupelian, P. A. (2002). Defining sexual outcomes after treatment for localized prostate carcinoma. Cancer, 95, 1773-1785.
Seidman, S. N., & Roose, S. P. (2000). The relationship between depression and erectile dysfunction. Current Psychiatry Reports, 2, 201-205.
Singer, P. A., Tasch, E. S., Stocking, C., Rubin, S., Siegler, M., & Weichselbaum, R. (1991). Sex or survival: Trade-offs between quality and quantity of life. Journal of Clinical Oncology, 9(2), 328-334.
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