Couples-based Interventions Following Prostate Cancer Treatment

A Narrative Review

Christian J. Nelson; Jessica C. Emanu; Isabelle Avildsen

Disclosures

Transl Androl Urol. 2015;4(2):232-242. 

In This Article

Abstract and Introduction

Abstract

Background/Objective: Sexual dysfunction following prostate cancer (PC) treatment often results in sexual avoidance and a loss of sexual intimacy, which can lead to relationship distress. This review aims to evaluate six studies intended to address relational and sexual intimacy following PC treatment and discuss methodological concerns which may help produce more effective interventions.

Methods: Electronic databases used to conduct literature searches included Medline, PsychINFO, and Web of Science. Studies were included if they were: randomized controlled trials (RCTs) using samples of men diagnosed with PC of any stage, had a psychosocial intervention, and addressed at least one sexual and relational outcome.

Results: As a whole, the literature has produced mixed results. While significant findings were reported, many of the primary hypotheses were not achieved. The six studies show that men with PC may benefit from education and support related to treatment options for erectile dysfunction (ED), whereas their partners may benefit more from interventions focused on relational issues. Important methodological limitations included: selection of general outcome measures as opposed to measures specific to sexuality or intimacy outcomes, lack of assessing distress or bother of the patient/couples as study entry criteria, heterogeneity of study populations, and lack of innovative intervention content as the current studies tested standard educational interventions, sex therapies techniques, and couples therapy strategies with only marginal success.

Conclusions: Interventions based on innovative theoretical approaches as well as study designs that address the outlined methodological limitations are needed in this area.

Introduction

In the U.S., over 200,000 new cases of prostate cancer (PC) will be diagnosed in 2015,[1,2] making it the most commonly diagnosed cancer in men. Of these cases, 90% will be diagnosed in the early stage due to effective screening and early detection.[3] With early detection, survival rates continue to increase and close to 100% of cases diagnosed in the U.S. will survive five years post-diagnosis.[4]

The combination of the large number of men diagnosed with PC, early detection, and effective treatment, has led to an increased focus on survivorship-related concerns following treatment for PC, of particular importance, erectile dysfunction (ED).[5] Data suggest that only 16% of men will return to their baseline erectile function following PC surgery.[6] Importantly, ED can have a significant negative psychological effect; men with ED report frustration and shame, an increase in depressive symptoms, and lower general life happiness.[6] The impact of ED can also extend to the couple. The psychological burden related to difficulties with erections often results in a loss of sexual and non-sexual intimacy, which, in turn, can lead to relationship distress.[7] Additionally, while men with PC may experience psychological distress, psychosocial research has emerged suggesting that female partners may experience equal, if not more distress than their male partners with PC.[8,9]

These findings suggest that high levels of distress may be present in both men with PC and their partners, and that this distress can have a negative impact on their relationship. Thus, there is a significant need for interventions that help the PC patient and his partner to manage and cope with the impact cancer treatment can have on their intimacy and relationship. The purpose of this paper is to review and to critically evaluate important intervention studies that intended to address relational and sexual intimacy following PC treatment. Possible methodological concerns are discussed in order to determine what is needed to produce more effective interventions in this area.

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