What are the ASCO guidelines to improve sexual function in male cancer survivors?

Updated: Feb 28, 2018
  • Author: Winston W Tan, MD, FACP; more...
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Answer

In addition to psychosocial counseling to potentially improve sexual functioning and satisfaction, ASCO recommends the use of agents and devices to promote erectile function also be considered, recognizing that most of the benefit is specifically for erectile dysfunction. Men who have sex with men may require additional education on the changes in erection and alternative ways to maintain sexual intimacy. [21]

Phosphodiesterase type 5 (PDE5) inhibitors can be used to help men with erectile dysfunction. [13, 21] Men should be aware that it might take a long time for medications to work and that PDE5 inhibitors might not work for all men, especially in those with preexisting comorbidities.Clinicians should discuss with patients the appropriate duration of use and alternative options (eg, surgery) if the medications fail to work satisfactorily.

Men who do not respond to PDE5 inhibitors should consider alternatives such as a vacuum erectile device (VED), medicated urethral system for erection, or intracavernosal injection. Surgical interventions, including penile prosthesis implantation for erectile dysfunction, can be offered to patients who do not respond to conventional medical therapy or who have adverse effects from it. [21]

Daily use of a VED is recommended to prevent penis length loss. Earlier initiation of VED use may be beneficial, as may early initiation of PDE5 inhibitors. [21]

Body image, including such issues as weight changes, disfigurement, scarring, and hair loss, should be discussed and normalized in men.

Clinicians should check testosterone levels, even if the patient has a cancer that is not typically associated with hormone changes. Options should be discussed when testosterone levels are within normal range but the patient or clinician feels that supplementation can have a clinical benefit and is not contraindicated. [21]

NCCN guidelines recommend testosterone therapy for men with total morning testosterone < 300 ng/dL. Lifestyle modifications, including increased physical activity, smoking cessation, and reduction in alcohol consumption, are also recommended. [13]


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