Recommendations for enhancing sexual rehabilitation for survivors of prostate cancer.

This study highlights psychosocial recommendations for survivors of prostate cancer (PCa) and their partners during sexual rehabilitation. The authors concluded that biopsychosocial programs are beneficial for providing educational support and psychosocial counseling to patients with erectile dysfunction in addition to existing biomedical strategies.

Survivors of PCa experience physical and psychological challenges due to the disease and its treatment. Erectile dysfunction (ED; the inability to achieve and maintain an erection during sex) is a type of sexual dysfunction commonly faced by survivors. Penile rehabilitation is a currently used medical therapy that facilitates blood flow to penile tissues through massages and periodic stimulations. However, medical and psychological factors can affect patient adherence and therefore treatment success.

Evidence supports the view that psychosocial considerations are equally important as medical therapy for treatment success for PCa survivors. However, current therapies for survivors do not include such considerations. It is important to support the needs of survivors of PCa and their partners after diagnosis by providing beneficial biopsychosocial recommendations through a sexual health rehabilitation action plan (SHRAP).

This study included 913 PCa survivors. Of these patients, 74% underwent radical prostatectomy (RP; prostate removal surgery), 13% had a combination therapy, 5% had radiation therapy (RT) and 2% had active surveillance (closely monitoring if PCa grows or spreads without actually treating it). Patients were provided with recommendations using a standardized 29-item list through SHRAP. SHRAP recommendations were biomedical, educational, psychosexual interventions or referrals based on individualized patient treatment plans. The frequency of recommendations provided to patients was assessed.

On average, patients had 2 appointments with 10 recommendations for every visit. Educational SHRAP recommendations were provided in 84% of visits and included penile rehabilitation, orgasmic guidelines, and management of climacturia (involuntary leaking urine during orgasm commonly occurring after RP).

Psychosexual recommendations were provided in 71% of visits, such as being pleasure-focused, dedicating time for sexual activity, simmering (cultivating sexually appealing thoughts or sensations), sexual aids, and nonsexual touching to promote intimacy. The most frequent recommendation was penile rehabilitation (84%) followed by pleasure-focus (71%). Penile rehabilitation was defined as penis massage stimulation and achieving at least 3 erections per week. Pleasure-focus was defined as focusing on pleasurable sensations instead of being goal-oriented. 

Overall, these recommendations were provided similarly among different types of treatments. However, survivors who received RP were more commonly prescribed educational recommendations. 

The study suggests that an integrative approach using educational and psychosocial strategies, together with existing biomedical approaches is beneficial to survivors of PCa.

SHRAP is presently not a validated tool and small numbers of patients had therapies other than surgery, making interpretations difficult.