Guidelines for Sexual Health Care for Prostate Cancer Patients: Recommendations of an International Panel
Authors: Wittmann Daniela , Mehta Akanksha , McCaughan Eilis , Faraday Martha , Duby Ashley , Matthew Andrew , Incrocci Luca , Burnett Arthur , Nelson Christian J. , Elliott Stacy , Koontz Bridget F. , Bober Sharon L. , McLeod Deborah , Capogrosso Paolo , Yap Tet , Higano Celestia , Loeb Stacy , Capellari Emily , Glodé Michael , Goltz Heather , Howell Doug , Kirby Michael , Bennett Nelson , Trost Landon , Odiyo Ouma Phillip , Wang Run , Salter Carolyn , Skolarus Ted A. , McPhail John , McPhail Susan , Brandon Jan , Northouse Laurel L. , Paich Kellie , Pollack Craig E. , Shifferd Jen , Erickson Kim , Mulhall John P. 
Published: October 2022

Background

Patients with prostate cancer suffer significant sexual dysfunction after treatment which negatively affects them and their partners psychologically, and strain their relationships.

Aim

We convened an international panel with the aim of developing guidelines that will inform clinicians, patients and partners about the impact of prostate cancer therapies (PCT) on patients’ and partners’ sexual health, their relationships, and about biopsychosocial rehabilitation in prostate cancer (PC) survivorship.

Methods

The guidelines panel included international expert researchers and clinicians, and a guideline methodologist. A systematic review of the literature, using the Ovid MEDLINE, Scopus, CINAHL, PsychINFO, LGBT Life, and Embase databases was conducted (1995–2022) according to the Cochrane Handbook for Systematic Reviews of Interventions. Study selection was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Each statement was assigned an evidence strength (A-C) and a recommendation level (strong, moderate, conditional) based on benefit/risk assessment, according to the nomenclature of the American Urological Association (AUA). Data synthesis included meta-analyses of studies deemed of sufficient quality (3), using A Measurement Tool to Assess Systematic Reviews (AMSTAR).

Outcomes

Guidelines for sexual health care for patients with prostate cancer were developed, based on available evidence and the expertise of the international panel.

Results

The guidelines account for patients’ cultural, ethnic, and racial diversity. They attend to the unique needs of individuals with diverse sexual orientations and gender identities. The guidelines are based on literature review, a theoretical model of sexual recovery after PCT, and 6 principles that promote clinician-initiated discussion of realistic expectations of sexual outcomes and mitigation of sexual side-effects through biopsychosocial rehabilitation. Forty-seven statements address the psychosexual, relationship, and functional domains in addition to statements on lifestyle modification, assessment, provider education, and systemic challenges to providing sexual health care in PC survivorship.

Clinical Implications

The guidelines provide clinicians with a comprehensive approach to sexual health care for patients with prostate cancer.

Strengths & Limitations

The strength of the study is the comprehensive evaluation of existing evidence on sexual dysfunction and rehabilitation in prostate cancer that can, along with available expert knowledge, best undergird clinical practice. Limitation is the variation in the evidence supporting interventions and the lack of research on issues facing patients with prostate cancer in low and middle-income countries.

Conclusion

The guidelines document the distressing sexual sequelae of PCT, provide evidence-based recommendations for sexual rehabilitation and outline areas for future research.