(384) International Clinical Guidelines for Sexual Health Care in Prostate Cancer Survivorship
Authors: Wittmann D , Mehta A , Mccaughan E , Faraday M , Duby A , Matthew A , Incrocci L , Burnett A , Nelson C J , Elliott S , Koontz B , Bober S , Mcleod D , Capogrosso P , Yap T , Higano C , Loeb S , Capellari E , Glodé M , Goltz H , Howell D , Kirby M , Bennett N , Trost L , Odiyo Ouma P , Wang R , Salter C , Skolarus T , McPhail J , McPhail S , Brandon J , Northouse L , Paich K , Pollack C , Shifferd J , Erickson K , Mulhall J 
Published: May 2023

Abstract

Introduction
During the past 20 years, researchers have studied various aspects of the impact of prostate cancer therapies on patients, partners and couples. Patients and partners reported distress and negative consequences for their relationships resulting from treatment-related sexual side-effects of prostate cancer therapies. Research on rehabilitation strategies in prostate cancer survivorship has focused largely on biomedical interventions although psychosexual intervention research is also gaining ground. This research has never been summarized in such a way that clinicians can use the findings to provide evidence-based support for prostate cancer patients and their partners in survivorship.

Objective
An international panel of experts has developed a guideline that informs clinicians, patients and partners about the impact of prostate cancer therapies on the sexuality of patients and partners, and on their sexual relationships. It provides guidance for biopsychosocial rehabilitation strategies that help patients and partners recover sexual intimacy after prostate cancer therapy.

Methods
The guideline panel included international, multidisciplinary clinical experts and researchers in prostate cancer, a reference librarian 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). The review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. Study selection is reported, based on PRISMA guidelines. Evidence for each statement was assigned a strength (A-C) and a level of recommendation (strong, moderate, conditional) which was based on benefit/risk balance. Data synthesis included meta-analyses of high-quality studies (determined by the Cochrane Risk of Bias tool).

Results
The guideline is contextualized within cultural, ethnic and racial diversity. The needs of individuals with diverse sexual orientations and gender identities are also recognized. Forty-seven statements were generated, guided by a theoretical model of sexual recovery after prostate cancer therapies and by principles that promote clinician-initiated discussion of realistic expectations of sexual outcomes and mitigation of sexual side-effects through biopsychosocial rehabilitation. The statements focus on counseling about the impact of prostate cancer therapies on patients’ and partners’ sexuality and couples’ relationships as well as on biomedical and psychosocial treatment strategies for sexual dysfunction. The guideline statements address the assessment of sexual function and distress, and barriers to providing sexual health care in prostate cancer survivorship in globally varied health care systems.

Conclusions
The guideline documents the distressing sexual sequelae of prostate cancer therapies and makes evidence-based recommendations for sexual rehabilitation in prostate cancer survivorship. Areas for future research are also outlined. The guideline was supported and funded by the Movember Foundation.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Author disclosures 1. Capogrosso 2. Northouse 3. Matthew 4. Elliott 5. Mulhall 6. Capellari 7. Incrocci 8. Faraday 9. Loeb 10. Mehta 11. Howell 12. McPhail J 13. McPhail S 14. Brandon 15. Paich 16. Erickson 17. Shifferd 18. Duby 19. Yap 20. Goltz 21. Odiyo 22. Salter 23. Nelson 24. McLeod 25. Trost 26. Wittmann – 10% salary paid by Movember 27. Bober – honorarium from UpToDate 28. Bennett - Endo Pharma - speaker 29. Coloplast - speaker, training grant. 30. Glode – Janssen, Aurora Oncology, Bayer, Exelixis, ProTechSure Scientific, Gonex, Patents, Seattle Genetics 31. Kirby – Lilly, Astra Zeneca, GSK, others 32. Wang – Boston Scientific, Teleflex, Coloplast 33. Pollack – Gilead 34. Burnett - Grant/research support: Endo Pharmaceutical, Boston Scientific, NIH Consultant/advisor: Boston Scientific, Coloplast, Reflexonic, Astellas, Novartis, Futura Medical, Comphya SA, Myriad Genetics Patent Holder: MHN Biotech Boards: UCF, AUA PAC, Mentoring Mae teens in the Hood Editor/editorial board: Urology Practice, Andrology, Canadian Journal of Urology, International Urology and Nephrology, Urology Times Other: UroMissionsWorks Inc (Non-profit) 35. Skolarus – UpToDate 36. Koontz - receives research funding from Janssen Scientific Affairs, Merck Pharmaceuticals, Blue Earth Diagnostics, and has received personal fees (ie advisory board) for Blue Earth Diagnostics.