Predicting Sex Life After Prostate Cancer
By TARA PARKER-POPE
Treatments for prostate cancer take a significant toll on male potency, leaving a surprisingly high percentage of men unable to have a normal sex life, new research shows.
The findings, based on a study of more than 1,000 men treated for prostate cancer at multiple medical centers, show that whether a man is able to achieve adequate erections after treatment for prostate cancer varies greatly depending on a number of individual variables, including his age, the extent of his cancer and the quality of his sex life before treatment.
Over all, fewer than half of the men who reported good sexual function before cancer had managed to regain it two years after treatment. But the chances of sexual recovery varied widely. After two years, some men had less than a 10 percent chance of achieving adequate erections after treatment, whereas others had a 70 percent or greater chance of a relatively normal sex life.
The results were not encouraging, but for the first time offer men a more personalized model for predicting sexual recovery after cancer treatment.
Cancer experts say the data, published Tuesday in The Journal of the American Medical Association, are sorely needed, in light of marketing efforts that are aimed at wooing men toward particular types of treatment but that often leave patients with unrealistic expectations. Many men report feeling shocked and depressed when their sex lives fail to return to normal after treatment.
“I think being transparent about what the pros and cons are, the reality — that’s important,’’ said Dr. Martin G. Sanda, senior author on the research and director of the prostate care center at
Beth Israel Deaconess Medical Center in . “For any of the treatments for prostate cancer, it would be misleading to tell someone they have a 100 percent chance of sexual recovery, or even a 95 percent chance. It’s easier for a couple to face that and deal with that if they are expecting it than if they were oversold and told there weren’t going to be any issues.” Boston
The study evaluated sexual function among men at nine academic medical centers who had undergone one of three treatments for prostate cancer: surgical removal of the prostate; radiation therapy; or brachytherapy, which uses radioactive seed implants.
Over all, just 35 percent of men in the surgery group, 37 percent of men in the radiation group and 43 percent of men in the brachytherapy group were able to have sexual intercourse two years after treatment.
Because the men weren’t randomly assigned to a treatment, the data don’t demonstrate whether one treatment is better than another. For instance, men who opt for brachytherapy are typically younger and healthier than men who undergo radiation treatment, so the results can’t be compared.
However, the researchers were able to determine which variables are most important for predicting a man’s erectile function after treatment. In all three treatment groups, the quality of a man’s erections before treatment — determined using a questionnaire about his sex life — helped predict his sexual recovery. Among surgical patients, a man’s age and his P.S.A. score, which measures prostate specific antigen, and whether he had nerve-sparing surgery also helped predict his chances of resuming a normal sex life. For men undergoing radiation treatment, those who had not also undergone hormone therapy were more likely to regain erectile function two years after treatment. Among men who had brachytherapy, a younger age and lower body weight helped predict a better recovery compared with men who were older or obese.
One limit of the study is that it followed the men for only two years. Men who undergo radiation and brachytherapy may experience a decline in erectile function two or more years after treatment, whereas men who undergo surgery may experience improvement.
Dr. Sanda said the data would allow doctors to take a more personalized approach as they talk to patients about the risks of a given treatment and counsel them about the benefits of drugs and other therapies that can improve erectile function.
“By and large, a lot of what we counsel men has been based on generalized average numbers,’’ said Dr. Sanda. “This really creates a more concrete metric as to what patients might expect.”