Skip to main content

Sexual rehabilitation recommendations for prostate cancer survivors and their partners from a biopsychosocial Prostate Cancer Supportive Care Program



This study aimed to highlight the biopsychosocial recommendations provided to prostate cancer survivors and their partners during sexual rehabilitation.


Retrospective analysis of a prospectively maintained patient database was conducted for visits between 2013 and 2019. The sexual health rehabilitation action plan (SHRAP) is a standardized 29-item list of biopsychosocial recommendations. The frequency of biopsychosocial recommendations provided to patients via their SHRAPs was assessed.


Among 913 patients, across 2671 appointments, nearly 74% of patients underwent radical prostatectomy. Other treatments included combination therapy (surgery, radiation, and/or androgen deprivation therapy (ADT)) (13%), radiation (external beam radiation or brachytherapy) (5%), and active surveillance (2%). Each patient had a median of 2 (SD 2.06) appointments and received a mean of 10.0 (SD 3.9) recommendations at each visit. Educational recommendations (penile rehabilitation, orgasmic guidelines, and climacturia management) were provided in 84% of visits followed by psychosexual recommendations (pleasure-focused, dedicated time, simmering, sexual aids, and sensate focus) in 71% of all appointments. The top recommendations (total n, frequency of recommendation) were penile rehabilitation (2253, 84%), pleasure-focus (1887, 71%), phosphodiesterase inhibitors (1655, 62%), clinical counselor (1603, 60%), vacuum erectile device (1418, 53%) and intracavernosal injections (1383, 52%).


Biopsychosocial programs are evolving to be a key part of prostate cancer survivorship. This study’s insight suggests that prostate cancer survivors require education around their sexual consequences and psychosexual counseling alongside proven biomedical strategies for erectile dysfunction.

Implications for cancer survivors

Cancer survivorship programs should integrate educational and psychosocial strategies alongside biological strategies for prostate cancer survivors and their partners.

This is a preview of subscription content, access via your institution.

Fig. 1

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.


  1. Fradet Y, Klotz L, Trachtenberg J, Zlotta A (2009) The burden of prostate cancer in Canada. Journal of the Canadian Urological Association 3:S102–S108

    Article  Google Scholar 

  2. Matthew AG, Alibhai SMH, Davidson T, Currie KL, Jiang H, Krahn M et al (2014) Health-related quality of life following radical prostatectomy: long-term outcomes. Quality of life research: an international journal of quality of life aspects of treatment, care and rehabilitation 23:2309–2317

    Article  Google Scholar 

  3. Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E et al (2016) Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 375:1425–1437

    CAS  Article  Google Scholar 

  4. Chen RC, Clark JA, Talcott JA (2009) Individualizing quality-of-life outcomes reporting: how localized prostate cancer treatments affect patients with different levels of baseline urinary, bowel, and sexual function. J Clin Oncol 27:3916–3922

    Article  Google Scholar 

  5. Wassersug R, Wibowo E (2017) Non-pharmacological and non-surgical strategies to promote sexual recovery for men with erectile dysfunction. Transl Androl Urol 6:S776–S794

    Article  Google Scholar 

  6. Aoun F, Peltier A, Van VR (2015) Penile rehabilitation after pelvic cancer surgery. Sci World J 2015:1–11

    Article  Google Scholar 

  7. Chisholm KE, McCabe MP, Wootten AC, Abbott JAM (2012) Review: Psychosocial interventions addressing sexual or relationship functioning in men with prostate cancer. J Sex Med 9:1246–1260

    Article  Google Scholar 

  8. Galbraith ME, Pedro LW, Jaffe AR, Allen TL (2008) Describing health-related outcomes differences and similarities. Oncol Nurs Forum 35:794–801

    Article  Google Scholar 

  9. Ramsey SD, Zeliadt SB, Blough DK, Moinpour CM, Hall IJ, Smith JL et al (2013) Impact of prostate cancer on sexual relationships: a longitudinal perspective on intimate partners’ experiences. J Sex Med 10:3135–3143

    Article  Google Scholar 

  10. Manne SL, Kissane DW, Nelson CJ, Mulhall JP, Winkel G, Zaider T (2011) Intimacy-enhancing psychological intervention for men diagnosed with prostate cancer and their partners: a pilot study. J Sex Med 8:1197–1209

    Article  Google Scholar 

  11. Walker LM, Wassersug RJ, Robinson JW. (2015) Psychosocial perspectives on sexual recovery after prostate cancer treatment. Nat Rev Urol. Nature Publishing Group. 12:167–76

  12. Goonewardene SS, Persad R (2015) Psychosexual care in prostate cancer survivorship: a systematic review. Transl Androl Urol 4:413–420

    PubMed  PubMed Central  Google Scholar 

  13. Reese JB, Keefe FJ, Somers TJ, Abernethy AP (2010) Coping with sexual concerns after cancer: the use of flexible coping. Support Care Cancer 18:785–800

    Article  Google Scholar 

  14. Elterman DS, Petrella AR, Walker LM, Van Asseldonk B, Jamnicky L, Brock GB et al (2019) Canadian consensus algorithm for erectile rehabilitation following prostate cancer treatment. Can Urol Assoc J 13:239–245

    Google Scholar 

  15. Matthew A, Lutzky-Cohen N, Jamnicky L, Currie K, Gentile A, Santa Mina D et al (2018) The prostate cancer rehabilitation clinic: a biopsychosocial clinic for sexual dysfunction after radical prostatectomy. Curr Oncol 25:393–402

    CAS  Article  Google Scholar 

  16. Elliott S, Matthew A (2018) Sexual recovery following prostate cancer: recommendations from 2 established Canadian Sexual Rehabilitation Clinics. Sex Med Rev 6:279–294

    Article  Google Scholar 

  17. Flannigan R, Sundar M, Weller S, Ivanov N, Hu M, Dayan M et al (2020) Pearls to pivoting a multidisciplinary prostate cancer survivorship program during the COVID-19 pandemic. Eur Urol Oncol 3:397–399

    Article  Google Scholar 

  18. Linschoten M, Weiner L, Avery-Clark C (2016) Sensate focus: a critical literature review. Sex Relatsh Ther 31:230–247

    Article  Google Scholar 

  19. Kim JH, Lee SW (2015) Current status of penile rehabilitation after radical prostatectomy. Korean J Urol 56:99–108

    Article  Google Scholar 

  20. Althof SE (2002) When an erection alone is not enough: biopsychosocial obstacles to lovemaking. Int J Impot Res 14:S99-104

    Article  Google Scholar 

  21. Walker LM, King N, Kwasny Z, Robinson JW (2017) Intimacy after prostate cancer: a brief couples’ workshop is associated with improvements in relationship satisfaction. Psychooncology 26:1336–1346

    Article  Google Scholar 

  22. Capogrosso P, Ventimiglia E, Cazzaniga W, Montorsi F, Salonia A (2017) Orgasmic dysfunction after radical prostatectomy. World J Men’s Health 35:1–13

    Article  Google Scholar 

  23. Skolarus TA, Wolf AMD, Erb NL, Brooks DD, Rivers BM, Underwood W et al (2014) American Cancer Society prostate cancer survivorship care guidelines. CA Cancer J Clin 64:225–249

    Article  Google Scholar 

  24. Ferguson J, Aning J (2015) Prostate cancer survivorship: a nurse-led service model. Br J Nurs 24:S14-21

    Article  Google Scholar 

  25. Paterick TE, Patel N, Tajik AJ (2017) Chandrasekaran K. Improving health outcomes through patient education and partnerships with patients. Baylor University Medical Center Proceedings [Internet]. Informa UK Limited; [cited 2021 May 6];30:112–3. Available from: /pmc/articles/PMC5242136/

  26. Brabers AEM, Rademakers JJDJM, Groenewegen PP, van Dijk L, de Jong JD (2017) What role does health literacy play in patients’ involvement in medical decision-making? PLoS ONE [Internet]. Public Library of Science; [cited 2021 May 6];12. Available from: /pmc/articles/PMC5336280/

Download references

Author information

Authors and Affiliations



Wallace Yuen: conception and design, administrative support, collection and assembly of data, data interpretation, manuscript writing, final approval of the manuscript.

Luke Witherspoon: administrative support, data interpretation, manuscript writing, final approval of the manuscript.

Eugenia Wu: conception and design, administrative support, collection and assembly of data, final approval of the manuscript.

Julie Wong: data collection.

Sara Sheikholeslami: data collection.

Jenna Bentley: conception and design, administrative support, final approval of the manuscript.

Christine Zarowski: conception and design, administrative support, final approval of the manuscript.

Monita Sundar: conception and design, administrative support, final approval of the manuscript.

Stacy Elliott: conception and design, administrative support, final approval of the manuscript.

Celestia Higano: conception and design, administrative support, final approval of the manuscript.

Ryan Flannigan: conception and design, administrative support, manuscript writing, final approval of the manuscript.

Corresponding author

Correspondence to Ryan Flannigan.

Ethics declarations

Ethics approval

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The IRB of the University of British Columbia approved this study.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Conflict of interest

Celestia S. Higano has received research grants from Aptevo, Aragon, Astellas, AstraZeneca, Clovis, Dendreon, eFFECTOR Therapeutics, Emergent, Ferring, Genentech, Hoffman-Laroche, Medivation, and Pfizer; she has also received personal fees from Astellas, Bayer, Blue Earth Diagnostics, Clovis, Dendreon, Ferring, Hinova, Janssen, Merck, Orion, Pfizer, Tolmar, Carrick Therapeutics, Novartis, and Genentech. Ryan Flannigan has received research grants from the Canadian Institute of Health Research, New Frontiers Research Fund, Vancouver Coastal Health Research Institute, and Canadian Urologic Association; he has also received funding from the American Society of Reproductive Medicine, Boston Scientific, Paladin Labs, and Acerus Labs. The other authors have no disclosures or conflicts of interest to report Fig. 3.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.



Fig. 2
figure 2

The abbreviated Sexual Health Rehabilitation Action Plan (SHRAP)

Fig. 3
figure 3

Frequency of biopsychosocial recommendations provided to patients based on treatment modality. (A) Frequency of specific biomedical recommendations based on treatment modality. (B) Frequency of specific educational recommendations based on treatment modality. (C) Frequency of specific psychosexual recommendations based on treatment modality. (D) Frequency of specific referral recommendations based on treatment modality. ADT = androgen deprivation therapy; Combination = surgery, radiation and/or ADT

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yuen, W., Witherspoon, L., Wu, E. et al. Sexual rehabilitation recommendations for prostate cancer survivors and their partners from a biopsychosocial Prostate Cancer Supportive Care Program. Support Care Cancer 30, 1853–1861 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Cancer survivorship
  • Sexual rehabilitation
  • Penile rehabilitation
  • Biopsychosocial
  • Survivorship program