Psychosexual Care in Prostate Cancer Survivorship

A Systematic Review

Sanchia Shanika Goonewardene; Raj Persad


Transl Androl Urol. 2015;4(4):413-420. 

In This Article

Abstract and Introduction


Background: Prostate cancer (PC) is the most common cancer in men. Due to improvements in medical care, the number of PC survivors is increasing. Current literature demonstrates survivors have significant unmet needs including psychosexual care. We assess patients psychosexual needs by systematic review of literature over the past 20 years up to May 2015 in order to see what issues need to be addressed within psychosexual care.

Methods: A systematic review was conducted on PC survivorship and psychosexual care. The search strategy aimed to identify all references related to PC survivorship programme components (parts of survivorship programmes) AND survivorship AND psychosexual concerns. Search terms used were as follows: (PC OR prostate neoplasms) AND (survivorship OR survivor*) OR [psychosexual impairment or sexual dysfunction or erectile dysfunction (ED)] AND [comorbidity or quality of life (QoL)].

Results: The systematic review identified 17 papers, examining unmet needs in psychosexual care post PC therapy.

Conclusions: These findings of this review may change psychosexual care of PC survivors, as national and international guidance is needed.


Meeting the needs is important.[1] Psychosexual concerns comprise psychological, emotional and physical factors. Therefore a bio-psycho-social approach to understanding psychosexual concerns is helpful.[2] This entails not only understanding the biology behind psychosexual concerns, but psychosocial reasons as to why psychosexual concerns occurred.[2]

The prostate cancer (PC) 'trifecta' post therapy, denotes oncological, continence and erectile dysfunction (ED) outcomes. This varies accord to type of radical therapy. The majority of men after radical prostatectomy, never regain preoperative levels of erectile function without further treatment.[2] This is compounded by an ageing physical function, worsening sexual function for men. Post radical therapy, there are side effects including reduced penile length, loss of desire, and loss of orgasmic satisfaction in the patient.[2] A recent focus group study found that sexual problems were associated with a variety of common physical adverse effects such as cardiovascular comorbidity.[3]

Patients with no psychosexual concerns pre-treatment can develop psychosexual concerns up to 14 months after radiotherapy.[4] Patients receiving localised radiotherapy still had psychosexual concerns at 3 years following radiotherapy (47.6% at 1 year and 19% at 3 years).[5] Psychosexual concerns include lack of ejaculation in 2–56%,[6–9] dissatisfaction with sexual intercourse in 25–60% of survivors,[10,11] decreased libido in 8–53%[12] and decreased sexual desire in 12–58% of survivors.[13,14]

The effect of brachytherapy on psychosexual concerns is also well documented.[14] This is composed of several factors including pre-brachytherapy-implant potency, age, combination external-beam irradiation, radiation dose delivered to prostate gland, and bulb of the penis. Taken together, psychosexual concerns after seed implantation, affects 30–64% of men.[15–19]

Furthermore with combination radiotherapy and brachytherapy, 63% of patients reported psychosexual concerns. Talcott and colleagues [2001] concluded that patients who had received combined brachytherapy and radiotherapy had a higher likelihood of psychosexual concerns.[20]