Why you need to better counsel PCa patients on sexual function

There’s a troubling disconnect between low-risk prostate cancer patients’ desire to preserve sexual function and the treatment choices they and their doctors often make, according to a study published online in the Journal of the National Cancer Institute (Oct. 16, 2017).   

“Prostate cancer is a unique disease where the vast majority of patients have multiple options to choose from. In addition, patients with low-risk prostate cancer can pursue active surveillance,” said senior author Ronald C. Chen, MD MPH, of the University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill.

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While positive, the existence of multiple treatment options also is challenging to urologists counseling patients.

“Because the different options have different impacts on patients’ quality of life, it is important for the urologist to ask patients about their preferences and priorities, then specifically discuss how available options affect these priorities for the patient. For example, if a low-risk prostate cancer patient expresses a strong preference to preserve his sexual function, then the urologist has the opportunity to counsel the patient that active surveillance may be the best option,” Dr. Chen said.

According to the study’s results, that quality-of-life conversation might not be happening as much as needed.

Dr. Chen and colleagues studied 1,194 men with localized prostate cancer, who had reported at baseline (before treatment) on sexual function and responded to whether preserving sexual function was very, somewhat, or not important. Among those studied, 568 men had low-risk prostate cancer.

Next: What the authors found

More than 52% of all the men indicated that preserving sexual function was very important, but there was no clear association between receiving active surveillance, which is the optimal strategy for preserving sexual function, and baseline sexual function or a strong preference to preserve sexual function. In other words, men with low-risk prostate cancer who wanted badly to preserve sexual function did not necessarily choose active surveillance, according to Dr. Chen.

Younger men were more likely to indicate a strong preference for preserving sexual function, as were men who had normal sexual function at the study’s start.

As a radiation oncologist who specializes in the care of prostate cancer patients, Dr. Chen said he wasn’t surprised by the study’s findings and thinks they send an important message.

“While there is increasing recognition that active surveillance is an excellent option for patients with low-risk prostate cancer, it is still underutilized in the U.S.,” he said. “I also believe that we, as physicians, are not currently doing a great job of asking patients about their preferences and priorities during the consultation. Our findings in this study indicate that there is room for improvement in these areas.”

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To better address the potential concern to preserve sexual function among their low-risk prostate cancer patients, urologists and other providers should first ask patients about their preferences and priorities, then individualize the recommendations based on the options that are medically appropriate, as well as take patients’ priorities into consideration.

“For some patients, sexual function may be very important. For others, having aggressive treatment may be the most important issue,” Dr. Chen said. “Our study showed that more than half of prostate cancer patients indicated a strong preference to preserve their sexual function, so, this is a highly clinically relevant issue to address during the consultation.”

Prostate cancer care, with its multiple treatment options, is an opportunity for physicians to provide patient-centered care, which helps each patient to make the decision that best fits his preferences and priorities, Dr. Chen said.

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