Retaining sexuality important factor in choosing Active Surveillance
Your brain is the biggest sex organ in your body--Dr. Anne Katz
One important reason that men with low- or intermediate-risk prostate cancer choose active surveillance (AS) is avoidance of the side effects common after surgery or radiation, including sexual problems. It is reported that 53% of men choose AS in order to preserve their sexual function (Broughman et al., 2018). However, men will often follow the recommendation of their urologist or radiation oncologist (Scherr, 2017) that may not consider the man’s interest in maintaining sexual and urinary function (Hoffman et al., 2018). Treatment regret is not uncommon after surgery or radiation with 23% of men reporting that they should have chosen less invasive treatment (van Stam et al., 2020). Men on AS report high levels of quality of life, an important factor to consider during the treatment decision-making phase after diagnosis (Lardas et al., 2017).
But do men who choose AS avoid sexual problems completely?
The short answer is no and this should not surprise anyone.
Anxiety plays a very real role in sexual function. Depending on the individual man, his emotional health, his relationship status (single or partnered), and the importance of sexual activity in his relationship(s), being on AS may impact his sexual function. Remember that the brain is the biggest sexual organ and will affect his penis, directly or indirectly. Anxiety affects desire, erections, and orgasms in a negative way.
Ever hear the term “performance anxiety”? This is a situation usually used in the context of the man’s ability to achieve and/or maintain an erection because anxiety impacts his erections. Anxiety about his cancer diagnosis, about a recent or upcoming PSA or prostate biopsy, his partner’s attitude to him being on AS, as well as pressure from family and friends about his choice of AS all may contribute to anxiety resulting in changes to his sexual functioning.
What can a man do when he experiences anxiety related to being on AS? For persistent anxiety, cognitive behavioral therapy (a form of counseling) or mindfulness-based meditation is very helpful. Exercise is very important and should be part of his daily routine. As the months and years pass, his anxiety is likely to decrease with lower levels of anxiety occurring especially when he is close to having a PSA test or prostate biopsy. Anti-anxiety medication should be a last resort as these medications are associated with sexual dysfunction including erectile dysfunction, loss of desire, and delayed orgasm (Segraves & Balon, 2014). Over time he may not experience anxiety at all or his anxiety will be significantly reduced.
References
Broughman, J. R., Basak, R., Nielsen, M. E., Reeve, B. B., Usinger, D. S., Spearman, K. C., . . . Chen, R. C. (2018). Prostate cancer patient characteristics associated with a strong preference to preserve sexual function and receipt of active surveillance. JNCI: Journal of the National Cancer Institute, 110(4), 420-425.
Hoffman, R. M., Van Den Eeden, S. K., Davis, K. M., Lobo, T., Luta, G., Shan, J., . . . Taylor, K. L. (2018). Decision-making processes among men with low-risk prostate cancer: A survey study. Psychooncology, 27(1), 325-332. doi:10.1002/pon.4469
Lardas, M., Liew, M., van den Bergh, R. C., De Santis, M., Bellmunt, J., Van den Broeck, T., . . . Bourke, L. (2017). Quality of Life Outcomes after Primary Treatment for Clinically Localised Prostate Cancer: A Systematic Review. Eur Urol, 72(6), 869-885. doi:10.1016/j.eururo.2017.06.035
Scherr, K. A., Fagerlin, A., Hofer, T., Scherer, L. Holmes-Rovner, M. Williamson, L. Kahn, V. Montgomery, J. Greene, K. Zhang, B. Uberl, P. . (2017). Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions. Medical Decision Making., 37(1), 56 - 69. doi:10.1177/0272989X16662841.
Segraves, R. T., & Balon, R. (2014). Antidepressant-induced sexual dysfunction in men. Pharmacol Biochem Behav, 121, 132-137. doi:10.1016/j.pbb.2013.11.003
Van Stam, M.-A., Aaronson, N. K., Bosch, J. L. H. R., Kieffer, J. M., van der Voort van Zyp, J. R. N., Tillier, C. N., . . . van der Poel, H. G. (2020). Patient-reported Outcomes Following Treatment of Localised Prostate Cancer and Their Association with Regret About Treatment Choices. Eur Urol Oncol, 3(1), 21-31. doi:https://doi.org/10.1016/j.euo.2018.12.004
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.
ZERO Summit support group on AS in March—be there, or be square
By Howard Wolinsky
For the past three years, I have run a special Active Surveillance support group for ZERO.
How about joining us at 11 a.m. Eastern March 12?
Register in advance for this meeting:
https://us02web.zoom.us/meeting/register/tZUsfuqgrjIoG9AWf7voMhzT_UjdqbQQbQPA
To each his/her own poison.
Perhaps the revised mantra of we older men: "sex, prescribed drugs, and rock and roll?: ?