Preference for Sexual Function Preservation Not Always Reflected in Treatment Choices, Study Finds

Preference for Sexual Function Preservation Not Always Reflected in Treatment Choices, Study Finds

While preserving sexual function was one of the most important factors for many men undergoing prostate cancer (PC) treatment, this preference was not reflected in the treatments chosen by men with low-risk PC, a new research study found.

The study detailing this finding, “Prostate Cancer Patient Characteristics Associated With a Strong Preference to Preserve Sexual Function and Receipt of Active Surveillance,” was published in the Journal of the National Cancer Institute.

Men with early-stage prostate cancer have multiple options with similar benefit, but that vary in terms of how it affects their quality of life. While active surveillance is the best option for preserving sexual function, it is not clear if a patient’s preference is affecting treatment selection.

To address this matter, researchers at the University of North Carolina Lineberger Comprehensive Cancer Center conducted a survey of nearly 1,200 prostate cancer patients in North Carolina.

The team found that more than half (52.6 percent) indicated that preserving sexual function was “very important.” However, this preference was not reflected in the treatment choices made by men with low-risk PC, researchers reported, which could indicate that patients might have been insufficiently informed about their options.

Of the 568 men identified in the survey as having low-risk PC, 43.4 percent received active surveillance. The approach consists on regular monitoring, ensuring that a patient receives treatment if the disease becomes more aggressive.

However, the researchers found that men who had a strong preference for preserving sexual function did not choose active surveillance more frequently than those who weren’t as concerned about preserving sexual function.

“Unfortunately, we found that men who had low-risk prostate cancer and wanted to preserve sexual function did not necessarily choose active surveillance,” Ronald C. Chen, MD, MPH, and associate professor in the UNC School of Medicine Department of Radiation Oncology, said in a press release. “This indicates that many patients may not have known about active surveillance as an option.”

Surgery, radiation therapy, and active surveillance are all treatment or monitoring options for patients with low-risk PC. But surgery and radiation therapy are more aggressive treatments that have side effects like sexual dysfunction, or decreased urinary function.

However, active surveillance is a strategy that allows men to undergo regular testing until the disease develops rather than undergo immediate treatment. Studies have shown that during the 10 years after diagnosis, most men (50-66 percent) on active surveillance don’t require treatment, allowing them to avoid the troublesome side effects experienced with other treatments.

This approach is widely recognized as the best strategy to preserve sexual function for this subset of patients.

“Active surveillance is widely recognized to be an excellent option for patients diagnosed with low-risk prostate cancer, because it is the best option to preserve the patient’s quality of life including sexual function,” Chen said. “Some patients with prostate cancer may initially want aggressive treatment, and it is important for the physician (urologist and radiation oncologist) to fully counsel patients about the slow-growing nature of low-risk prostate cancer and that active surveillance is a safe option,” he said.

These results seem to suggest there is a disconnect between patients’ preferences and treatment options available to them, Chen argued.

“The takeaway for prostate cancer patients is that they should always ask two important questions,” Chen added. “One, how aggressive is my cancer? Two, what are my options? After understanding this, it is important they communicate with their doctor what their priorities are in making a decision among the available options.”

Physicians also need to counsel their patients, helping them choose a treatment that better reflects their preferences.

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2 comments

  1. Lawrence Glickman says:

    The assumption that men who are not choosing “Active Surveillance” are not “Aware” of this option is simply not true. Any man with elevated PSA leading to a cancer diagnosis is always offered options by his general practitioner, oncologist or surgeon. The reason they often do not choose that option is because they have opted for more aggressive and possibly curative procedures. These days there are also a wide variety of less invasive treatment options that have high rates of sexual potency retention.

    • Michael J White says:

      Rubbish.Patients are treated like ignorant children and doctors more often than not state the risks of ED are 50/50 that is palpable rubbish and often doctors are very laconic and offer radical prostatectomy and radiation without differentiating the different radiation options. Few doctors are familiar with focal therapy such as HIFU and patients suitability.Nor have the knowledge of focal cryoablation that has a small ED risk whereas full cryosurgery is almost 100%ED resulting from full cryosurgery. Doctors are condescending and arrogant and are not fully aware of the percentages associated with different treatments.Also each patient will have different libido and ED functionality prior to any treatment that will affect any outcome.

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