Page 1 - Algorithm for erectile rehabilitation following prostate cancer treatment
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consensus statement
Canadian consensus algorithm for erectile rehabilitation following
prostate cancer treatment
Dean S. Elterman, MD ; Anika R. Petrella, MD ; Lauren M. Walker, MD ;Brandon Van Asseldonk, MD ;
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Leah Jamnicky, MD ; Gerald B. Brock, MD ; Stacy Elliott, MD ; Antonio Finelli, MD ; Jerzy B. Gajewski, MD ;
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Keith A. Jarvi, MD ; John Robinson, MD ; Janet Ellis, MD ; Shaun Shepherd, MD ; Hossein Saadat, MD ;
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Andrew Matthew, MD 1
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1 Division of Urology, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Department of Surgery, St. Joseph’s Hospital,
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London, ON, Canada; Department of Urology, Dalhousie University, Halifax, NS, Canada; Murray Koffler Urologic Wellness Center, Mount Sinai Hospital, Toronto, ON, Canada; Clinical Psychology
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Department, University of Calgary, Calgary, AB, Canada; Department of Psychology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Cite as: Can Urol Assoc J 2019;13(8):239-45. http://dx.doi.org/10.5489/cuaj.5653 Introduction
Prostate cancer (PCa) is the second most frequent cancer
Published online December 3, 2018 found in men, accounting for 21% of the estimated new
annual cancer cases. A number of treatment options are
1,2
Abstract available to patients with PCa, including active surveillance
(AS), radiotherapy (RT), and radical prostatectomy (RP).
Introduction: The present descriptive analysis carried out by a Treatment options are chosen based on a number of fac-
pan-Canadian panel of expert healthcare practitioners (HCPs) tors, such as clinical stage, patient’s age, and the presence
summarizes best practices for erectile rehabilitation following of comorbid diseases in the patient. 3,4
prostate cancer (PCa) treatment. This algorithm was designed to PCa treatments, regardless of modality, increase the likeli-
support an online sexual health and rehabilitation e-clinic (SHARe- hood of erectile dysfunction (ED). Rates for ED lasting two
5
Clinic), which provides biomedical guidance and supportive care 5,6
to Canadian men recovering from PCa treatment. The implications years or more following RP range from 66‒75%. Similar
of the algorithm may be used to inform clinical practice in com- results are reported in men following RT at three years
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munity settings. (37‒81%). ED rates have been found to be 10- to 15-fold
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Methods: Men’s sexual health experts convened for the TrueNTH higher in men with PCa than their similarly aged peers. ED
Sexual Health and Rehabilitation Initiative Consensus Meeting to is a significant threat to the quality of life of men diagnosed
address concerns regarding erectile dysfunction (ED) therapy and with PCa, as 60% of affected men experience severe distress
management following treatment for PCa. The meeting brought from ED. 9-11 The loss of sexual activity and resultant chal-
together experts from across Canada for a discussion of current prac- lenge to masculinity have been shown to negatively affect
tices, latest evidence-based literature review, and patient interviews. quality of life. 12
Results: An algorithm for ED treatment following PCa treatment is Currently, there remains a gap in the systematic and com-
presented that accounts for treatment received (surgery or radia- prehensive care of sexual dysfunction after PCa treatment.
tion), degree of nerve-sparing, and level of pro-erectile treatment
invasiveness based on patient and partner values. This algorithm This presents a significant barrier to continuity of care for
provides an approach from both a biomedical and psychosocial PCa survivors across Canada. The TrueNTH SHARe Clinic
focus that is tailored to the patient/partner presentation. Regular was developed to provide sexual health support to men
sexual activity is recommended, and the importance of partner across Canada. The present manuscript incorporates research
involvement in the treatment decision-making process is high- evidence, patient perspectives, and clinical expertise from
lighted, including the management of partner sexual concerns. experts in the field. To address the lack of consistency in
Conclusions: The algorithm proposed by expert consensus consid- care of sexual dysfunction after PCa treatment, a meeting
ers important factors like the type of PCa treatment, the timeline was held. The TrueNTH Sexual Health and Rehabilitation
of erectile recovery, and patient values, with the goal of becom- Initiative Consensus Meeting was held with the purpose of
ing a nationwide standard for erectile rehabilitation following developing an ED therapy algorithm following PCa treat-
PCa treatment.
ment. The algorithm would be disseminated and used in the
TrueNTH SHARe Clinic. The present manuscript describes
the development of an ED therapy algorithm that uniquely
CUAJ • August 2019 • Volume 13, Issue 8 239
© 2019 Canadian Urological Association