'Age is not a friend to the penis'--Dr. Anne Katz in her debut 'Sex & Surveillance' column
Happy Thanksgiving to U.S. readers.
By Howard Wolinsky
Recently, an attendee to a support group for men on Active Surveillance (AS) spoke about his experiences following a radical prostatectomy for Gleason 7 cancer.
He was very frank about how he regained his sexuality.
It was a rare moment—and fellow attendees hung his every word.
Retaining sexuality is one of the key objectives—maybe the most important—for those who opt for AS, close monitoring rather than aggressive treatment with risks of erectile dysfunction and incontinence. But it’s amazing how rarely the “S” word comes up in support meetings with these men.
The late Dr. Gerald Chodak, the grandfather of AS and a friend of mine dating back to the early 1980s when I was the medical editor of the Chicago Sun-Times, used to tell me how urologists did themselves no favor by not taking a thorough sexual history before performing prostate surgery. He said patients are quick to blame surgery for loss of sexual function, when it actually may be a function of the aging process.
Dr. Anne Katz, an expert on sexuality and cancer, will be addressing this “elephant in the room” in her new column “Sex & Surveillance” in TheActiveSurveillor.com.
Dr. Katz is one of the experts I enlisted to answer your questions. Please send questions about sexuality, urology, pathology, radiology, and lifestyle to mailto:pros8canswers@gmail.com
In this first column, I am writing about male sexuality and the impact of increasing age on sexual function.
Erectile dysfunction (ED) is defined as a persistent failure to achieve and maintain an erection sufficient for sexual intercourse (NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence; 1993). The Massachusetts Male Aging Study (MMS) reported a three-fold increase in ED between the ages of 40 and 70 years. Sixty-four percent of men aged 70 and over reported ED in the European Male Aging Study (EMAS) (Corona et al., 2010).
Despite how old we feel, changes in sexual function are inevitable for both men and women. This is a biological fact. Sexual functioning is complex. Erections are dependent on healthy nerves and blood vessels. Sexual desire or libido in men is driven by testosterone and a decline in levels of this hormone naturally decreases over time, starting at about age 40. Conditions that affect the cardiovascular system (hypertension for example) and nervous system (e.g. diabetes) are known to impact sexual function. Additionally, tobacco use, certain medications, alcohol and/or recreational drug use, and obesity are risk factors for ED.
Mental health problems, such as depression and/or anxiety, also have a negative impact on erections; absent or altered sexual desire and loss of erections can impact mental health. This bi-directional association is complex and treatment is not simple. Erectile function is not an on-and-off phenomenon as many people think.
ED is clearly a significant issue for men as they age. And prostate cancer is a disease associated with aging. For men who are on active surveillance, changes in erections are mostly due to factors associated with aging, but also with the emotional impact of a cancer diagnosis.
My next column will address the impact of active surveillance on sexual function but first I wanted to set the stage by talking about the aging male and sexuality.
Please send your questions of a general nature about active surveillance and prostate cancer to mailto:pros8canswers@gmail.com
References
Corona G, Lee DM, Forti G, Connor DB, Maggi M, O’Neill TW, Pendleton N, Bartfai G, Boonen S, Casanueva FF, Finn JD, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean ME, Punab M, Silman AJ, Vanderschueren D, Wu FC. EMAS Study Group. Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study 2 (EMAS). J Sex Med. 2010 Apr;7(4 Pt 1):1362-80. doi: 10.1111/j.1743-6109.2009.01601.x. Epub 2009 Nov 19. PMID: 19929914.
NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. (1993). Jama, 270(1), 83-90.
Dr. Anne Katz is the certified sexuality counselor and Clinical Nurse Specialist at CancerCare Manitoba in Winnipeg, Canada. She is the immediate past editor of the Oncology Nursing Forum, the premier research journal of the Oncology Nursing Society. She was recently appointed as Associate Editor of CA: A Cancer Journal for Clinicians (American Cancer Society). She was inducted into the American Academy of Nursing in 2014. She is the author of 15 books for healthcare providers and healthcare consumers on the topics of illness and sexuality as well as cancer survivorship.
Reminder: Survey focuses on how prostate cancer impacts partners
By Howard Wolinsky
Prostate cancer is a couple’s disease.
Whatever your diagnosis—from very low-risk to very high-risk—your spouse, partner, significant other, etc. is impacted. In the case of Active Surveillance, your partner’s perspective can make or break the decision to be surveilled vs. treated.
EU-ProPer partners’ study
Antwerp-based Europa Uoma, a European advocacy organization for men with prostate cancer and their partners, representing 26 national patients’ groups, has done excellent research surveying men with prostate cancer. Now they are conducting an anonymous survey in Europe and beyond to learn about the experiences of partners of men with prostate cancer and the physical and psychological burdens the disease imposes on them.
Europa Uomo Chairman Guenther Carl said that the study builds on the knowledge gained from previous Europa Uomo studies about patients’ quality of life after treatment (the EUPROMS studies).
“Our EUPROMS surveys have gone some way to identify the burden of prostate cancer on the daily lives of affected men,” he said. “But we also know from our own experience that the effect on partners and caregivers can be considerable. If we can find out what would really help partners, it could have a significant impact on the type of support provided after diagnosis.”
He said the survey will help define unmet needs and provide an agenda for action.
The study, named EU-PROPER (Europa Uomo Prostate Cancer Partners in Europe Research), is available online in 17 languages. Pick your favorite.
Go to euproper.org to complete the survey
Now an unsolicited word from a reader
“Howard, your work is just terrific. I consider myself to be unusually well-informed about prostate cancer, but I’ve learned a number of important things from reading your posts. Please keep it up! You are providing a lot of value. Thanks, Bill Fagan, Naples, Florida.”
Why not get a paid subscription like Bill did?
Join us ringside at ZERO support group on AS in March
By Howard Wolinsky
For the past three years, I have run a special Active Surveillance support group for ZERO. Last year, our virtual support meeting drew 60 patients to talk about AS. By far, it was the biggest session of any at the annual ZERO Summit.
I’m hoping we can beat that record at 11 a.m. Eastern on March 12, 2024.
I’ve set up the meeting and figured why not put out the word early.
It also will help in planning. If we get over 100 sign-ups, I’ll have to convert to a webinar so no one gets turned away.
So sign up now and join us at 11 a.m. Eastern March 12 March.
Register in advance for this meeting:
https://us02web.zoom.us/meeting/register/tZUsfuqgrjIoG9AWf7voMhzT_UjdqbQQbQPA