madman
Super Moderator
Neglected side effects to curative prostate cancer treatments
Alexander B. Nolsøe ● Christian Fuglesang S. Jensen ● Peter B. Østergren ● Mikkel Fode
Abstract
In this narrative review, we summarize the neglected side effects of curative intended treatment for prostate cancer. They include climacturia, arousal incontinence (AI), orgasmic disturbances such as altered orgasmic sensation, anorgasmia, and orgasm associated pain (dysorgasmia), ejaculatory dysfunction, and morphological penile alterations in the form of shortening and deformity. Even though they have not received as much interest as erectile dysfunction (ED) or urinary incontinence, these side effects have been shown to negatively impact the patient’s quality of life. They are common and rates of climacturia after radical prostatectomy (RP) range from 20% and 45%, less after external beam radiation therapy (EBRT). Decreased orgasmic sensation ranges from 3.9% to 60% after RP and between 36–57% after EBRT. Dysorgasmia ranges from 9.5–15% for both RP and EBRT. Anejaculation after EBRT ranges from 11–71% and rates of penile shortening are reported between 0 and 100%. There are no internationally validated questionnaires that adequately assess these side effects. This is necessary if we are to align patient and partner expectations properly and consequently manage them optimally. Neglected side effects should be discussed with patients and their partners preoperatively, as they are associated with bother and may lead to patients avoiding sexual activity.
Introduction
Prostate cancer has an estimated worldwide incidence of 1.3 million and mortality of 359,000 [1] per year. Established curative treatments include radical prostatectomy (RP), external beam radiation therapy (EBRT) possibly in combination with androgen deprivation therapy, and brachytherapy. The 10-year prostate cancer-specific survival rates for EBRT and RP ~99% [2] so attention should be paid to the adverse effects caused by treatments. Regarding functional outcomes, most attention has gone toward erectile dysfunction (ED), urinary incontinence (UI), and bowel dysfunction [3, 4]. However, there are a wide range of sexual side effects that are often overlooked even though they are common [5, 6] and affect patients’ quality of life [5, 7]. They have received increasing interest and are collectively termed “Neglected side effects” [5]. They include climacturia, arousal incontinence (AI), orgasmic and ejaculatory disturbances, and penile anatomical changes. In this narrative review, we gave an interest in original research reporting on side effects other than the only UI and/or ED from January 1990 to April 2020. The aim is to summarize the neglected side effects following the different curative treatments for prostate cancer.
*Climacturia
*Arousal incontinence
*Orgasmic and ejaculatory disturbances
*Altered orgasmic sensation and anorgasmia
*Dysorgasmia
*Ejaculatory dysfunction
*Penile anatomical changes
Conclusion
With the wide range of different sexual side effects, it seems obvious that too much emphasis is put on ED and so-called penile rehabilitation after curative treatment for prostate cancer. There is a need adequate for internationally validated questionnaires. Further, more research is needed to identify possible treatments, and studies on brachytherapy are warranted to compare side effects across treatments and inform patients properly. More importantly, the post-treatment focus needs to be shifted to much broader sexual rehabilitation programs. As similar side effects may cause different degrees of bother, such programs need to incorporate the needs and wishes of patients and their partners and consider the specific sexual practices of individual men. The main goal is to facilitate a feasible and pleasurable sexual life.
Alexander B. Nolsøe ● Christian Fuglesang S. Jensen ● Peter B. Østergren ● Mikkel Fode
Abstract
In this narrative review, we summarize the neglected side effects of curative intended treatment for prostate cancer. They include climacturia, arousal incontinence (AI), orgasmic disturbances such as altered orgasmic sensation, anorgasmia, and orgasm associated pain (dysorgasmia), ejaculatory dysfunction, and morphological penile alterations in the form of shortening and deformity. Even though they have not received as much interest as erectile dysfunction (ED) or urinary incontinence, these side effects have been shown to negatively impact the patient’s quality of life. They are common and rates of climacturia after radical prostatectomy (RP) range from 20% and 45%, less after external beam radiation therapy (EBRT). Decreased orgasmic sensation ranges from 3.9% to 60% after RP and between 36–57% after EBRT. Dysorgasmia ranges from 9.5–15% for both RP and EBRT. Anejaculation after EBRT ranges from 11–71% and rates of penile shortening are reported between 0 and 100%. There are no internationally validated questionnaires that adequately assess these side effects. This is necessary if we are to align patient and partner expectations properly and consequently manage them optimally. Neglected side effects should be discussed with patients and their partners preoperatively, as they are associated with bother and may lead to patients avoiding sexual activity.
Introduction
Prostate cancer has an estimated worldwide incidence of 1.3 million and mortality of 359,000 [1] per year. Established curative treatments include radical prostatectomy (RP), external beam radiation therapy (EBRT) possibly in combination with androgen deprivation therapy, and brachytherapy. The 10-year prostate cancer-specific survival rates for EBRT and RP ~99% [2] so attention should be paid to the adverse effects caused by treatments. Regarding functional outcomes, most attention has gone toward erectile dysfunction (ED), urinary incontinence (UI), and bowel dysfunction [3, 4]. However, there are a wide range of sexual side effects that are often overlooked even though they are common [5, 6] and affect patients’ quality of life [5, 7]. They have received increasing interest and are collectively termed “Neglected side effects” [5]. They include climacturia, arousal incontinence (AI), orgasmic and ejaculatory disturbances, and penile anatomical changes. In this narrative review, we gave an interest in original research reporting on side effects other than the only UI and/or ED from January 1990 to April 2020. The aim is to summarize the neglected side effects following the different curative treatments for prostate cancer.
*Climacturia
*Arousal incontinence
*Orgasmic and ejaculatory disturbances
*Altered orgasmic sensation and anorgasmia
*Dysorgasmia
*Ejaculatory dysfunction
*Penile anatomical changes
Conclusion
With the wide range of different sexual side effects, it seems obvious that too much emphasis is put on ED and so-called penile rehabilitation after curative treatment for prostate cancer. There is a need adequate for internationally validated questionnaires. Further, more research is needed to identify possible treatments, and studies on brachytherapy are warranted to compare side effects across treatments and inform patients properly. More importantly, the post-treatment focus needs to be shifted to much broader sexual rehabilitation programs. As similar side effects may cause different degrees of bother, such programs need to incorporate the needs and wishes of patients and their partners and consider the specific sexual practices of individual men. The main goal is to facilitate a feasible and pleasurable sexual life.
