Achieve optimal outcomes in sexual function post prostate cancer therapy by understanding realistic expectations, seeking pre-therapy referral to a sexual medicine clinician, and discussing strategies to address sexual dysfunctions.
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Presentation Transcript
Sexual Function Outcomes Sexual Function Outcomes After Prostate Cancer Therapy After Prostate Cancer Therapy Know Your Goals Know Your Goals John P. Mulhall MD MSc FECSM FACS FRCSI John P. Mulhall MD MSc FECSM FACS FRCSI Director, Sexual & Reproductive Medicine Urology Service Memorial Sloan Kettering Cancer Center, NY, USA
Disclosures Grants Grants NIH DOD Sexual Medicine Society of North America Center for Intimacy after Cancer Therapy Consultancies Consultancies None Other Other Past-President of the Sexual Medicine Society of North America Editor-in-Chief, The Journal of Sexual Medicine
Optimal Outcomes Achieving optimal outcomes requires full informed consent informed consent before treatment which requires that the clinician gives realistic expectations expectations about the effectiveness and side effects of treatment realistic
My Goal To give you advice to help you enter any treatment program with your eyes wide open
Treatment Effects The only sex-friendly prostate cancer management strategy is active surveillance
Realistic Expectations Referral pre-therapy to a sexual medicine clinician Discussion of frequency of the major sexual problems Discussion of time-course of recovery Discussion of ways to minimize long-term effects Discussion of strategies to treat side effects
Sexual Dysfunctions Erectile dysfunction (ED) Decreased sex drive Failure to ejaculate Difficulty achieving orgasm Reduced orgasm intensity Orgasmic pain (Dysorgasmia) Sexual incontinence (arousal, climacturia) Penile length (volume) loss
#2 #2 You think that your treating clinician will tell you all you need to hear, when in fact, the physician will tell you what they think you need to hear
#3 #3 Don t be afraid to ask why active surveillance is not an option for you
#4 #4 Before committing to a treatment think seriously about how important your future sex life is
#6 #6 Understand what your treating physician means by erectile function preservation/recovery
#8 #8 Get realistic expectations about the time-frame for sexual function recovery/preservation
EF Recovery after RP 400 376 362 352 332 321 289 1053 1025 945 908 888 851 811 776 751 713 677 648 597 547 508 465 447 425 40% Recovery of Full Erections 30% 20% 10% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Time (months) from Radical Prostatectomy
EF Recovery after RT Entire cohort AD- AD+ 30 25 EFD score 20 15 10 5 0 12m 24m 36m Duration post-BT Teloken P, et al. JSM 2009
#17 #17 Beware physicians citing incredible figures for erectile function recovery/preservation
#18 #18 If you have ED before treatment and sexual intercourse is important, it is essential that you communicate its importance to the treating physician
