Guidelines for Sexual Health Care for Prostate Cancer Patients: Recommendations of an International Panel

Daniela Wittmann*, Akanksha Mehta, Eilis McCaughan, Martha Faraday, Ashley Duby, Andrew Matthew, Luca Incrocci, Arthur Burnett, Christian J. Nelson, Stacy Elliott, Bridget F. Koontz, Sharon Bober, Deborah McLeod, Paolo Capogrosso, Tet Yap, Celestia Higano, Stacy Loeb, Emily Capellari, Michael Glodé, Heather GoltzDoug Howell, Michael Kirby, Nelson Bennett, Landon Trost, Phillip Odiyo Ouma, Run Wang, Carolyn Salter, Ted A. Skolarus, John McPhail, Susan McPhail, Jan Brandon, Laurel L. Northouse, Kellie Paich, Craig E. Pollack, Jen Shifferd, Kim Erickson, John P. Mulhall

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

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. 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 guideline accounts for patients’ cultural, ethnic, and racial diversity. It attends to the unique needs of individuals with diverse sexual orientations and gender identities. The guideline is 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, provides evidence- based recommendations for sexual rehabilitation and outline areas for future research. Wittmann D, Mehta A, McCaughan E, et al. Guidelines for Sexual Health Care for Prostate Cancer Patients: Recommendations of an International Panel. J Sex Med 2022;XX:XXX–XXX.

Original languageEnglish
Pages (from-to)1655-1669
Number of pages15
JournalJournal of Sexual Medicine
Volume19
Issue number11
DOIs
Publication statusE-pub ahead of print - 1 Oct 2022

Bibliographical note

Publisher Copyright: © 2022 International Society for Sexual Medicine

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