Prostate Cancer Rehabilitation: Outcomes of a Sexual Health Clinic
Radical prostatectomy (RP) leaves 45-75% of patients with long-term sexual dysfunction (SD). Approximately 60% of patients report significant emotional distress related to their SD that may progress to maladjustment in their relationships with partners. Despite high levels of effectiveness, 30-50% of patients who turn to sexually assistive aids after RP discontinue use of the aids within one year. The available research exploring this gap between effectiveness and ongoing use supports a broader perspective of SD that includes psychological, behavioural, social and interpersonal factors. In addressing this need we have developed the Prostate Cancer Rehabilitation Clinic (PCRC), at Princess Margaret Cancer Centre in Toronto, Canada. The aim of the PCRC is to assist patients and couples in achieving optimal sexual health and maintaining intimacy.
The PCRC emphasizes multidisciplinary intervention teams, the active participation of the partner, and a broad-spectrum bio-psychosocial intervention approach. The program includes seven clinic visits across two years and provides both biomedical and psychological support for SD. We conducted a retrospective study comparing Health-Related Quality of Life (HRQoL) patient-reported outcomes from patients who had RP in 2006 (prior to PCRC, n=304) and 2012 (after PCRC, n=342).
Patients who had a RP in the year of 2012 were 1.9 times more likely to have sexual function 2 years post-surgery compared to patients who had RP in 2006 (35.8% vs 19.2%, P < 0.001). Patients who attended the PCRC were more likely to take pro-erectile medications 2 year post-surgery (86.2% vs 38%) and had a stable level of intimacy and anxiety over the 2 year course. These results were maintained when potential confounders across comparison years were controlled for, including introduction of robotic-RP, changes in surgical staff, and disease characteristics. Patients and partners who attended the PCRC also reported a very high rate of satisfaction (95.8% for patients and 99.6% for partners) with the care they received at the clinic.
The PCRC has proved beneficial to RP patients and their partners in achieving better sexual health, continued use of pro-erectile medications, and maintenance of intimacy and low anxiety.