OBJECTIVE: To explore perceptions of the impact of erectile dysfunction on men who had undergone definitive treatment for early nonmetastatic prostate cancer.
DESIGN: Seven focus groups of men with early prostate cancer. The groups were semistructured to explore men’s experiences and quality-of-life concerns associated with prostate cancer and its treatment.
SETTING: A staff model health maintenance organization, and a Veterans Affairs medical center.
PATIENTS: Forty-eight men who had been treated for early prostate cancer 12 to 24 months previously.
RESULTS: Men confirmed the substantial effect of sexual dysfunction on the quality of their lives. Four domains of quality of life related to men’s sexuality were identified: 1) the qualities of sexual intimacy; 2) everyday interactions with women; 3) sexual imagining and fantasy life; and 4) men’s perceptions of their masculinity. Erectile problems were found to affect men in both their intimate and nonintimate lives, including how they saw themselves as sexual beings.
CONCLUSIONS: Erectile dysfunction, the most common side effect of treatment for early prostate cancer, has far-reaching effects upon men’s lives. Assessment of quality of life related to sexual dysfunction should address these broad impacts of erectile function on men’s lives. Physicians should consider these effects when advising men regarding treatment options. Physicians caring for patients who have undergone treatment should address these psychosocial issues when counseling men with erectile dysfunction.
prostate cancer erectile dysfunction quality of life qualitative methods
Walsh PC, Epstein LI, Lowe FC. Potency following radical prostatectomy with wide unilateral excision of the neurovascular bundle. J Urol. 1987;138:823–7.PubMedGoogle Scholar
Talcott JA, Rieker P, Clark JA, et al. Patient-reported symptoms after primary therapy for early prostate cancer: results of a prospective cohort study. J Clin Oncol. 1998;16:275–83.PubMedGoogle Scholar
Smith D, et al. Quality-of-life outcomes for men with prostate carcinoma detected by screening. Cancer. 2000;88:1454–63.PubMedCrossRefGoogle Scholar
Stanford J, et al. Urinary and sexual funcion after radical prostatectomy for clinically localized prostate cancer. JAMA. 2000;283:354–60.PubMedCrossRefGoogle Scholar
Clark JA, Rieker P, Propert KJ, Talcott JA. Changes in quality of life following treatment for early prostate cancer. Urology. 1999;53(1):161–8.PubMedCrossRefGoogle Scholar
Litwin MS, Nied RJ, Dhanani N. Health-related quality of life in men with erectile dysfunction. J Gen Intern Med. 1998;13(3):159–66.PubMedCrossRefGoogle Scholar
Helgason AR, Fredrikson M, Adolfsson J, Steineck G. Decreased sexual capacity after external radiation therapy for prostate cancer impairs quality of life. Int J Radiat Oncol Biol Phys. 1995;32(1):33–9.PubMedCrossRefGoogle Scholar
Helgason AR, Adolfsson J, Dickman P, Fredrikson M, Arver S, Steineck G. Waning sexual function—the most important disease-specific distress for patients with prostate cancer. Br J Cancer. 1996;73(11):1417–21.PubMedGoogle Scholar
Roach M III, Chinn DM, Holland J, Clarke M. A pilot survey of sexual function and quality of life following 3D conformal radiotherapy for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 1996;35(5):869–74.PubMedCrossRefGoogle Scholar
Helgason AR, Arver S, Adolfsson J, Dickman P, Granath F, Steineck G. ‘Potency’: the validation of information from a self-administered questionnaire using objective measurements of night-time erections and test-retest reliability. Br J Urol. 1998;81(1):135–41.PubMedGoogle Scholar
Perez MA, Meyerowitz BE, Lieskovsky G, Skinner DG, Reynolds B, Skinner EC. Quality of life and sexuality following radical prostatectomy in patients with prostate cancer who use or do not use erectile aids. Urology. 1997;50(5):740–6.PubMedCrossRefGoogle Scholar
Miles BJ, Giesler B, Kattan MW. Recall and attitudes in patients with prostate cancer. Urology. 1999;53(1):169–74.PubMedCrossRefGoogle Scholar
Talcott JA, Rieker P, Propert KJ, et al. Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy. [see comments]. J Natl Cancer Inst. 1997;89(15):1117–23.PubMedCrossRefGoogle Scholar
Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG. Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology. 2000;56:899–905.PubMedCrossRefGoogle Scholar
Marsiglio W, Donnelly D. Sexual relations in later life: a national study of married persons. J Gerontol. 1991;46(6):338S-344S.Google Scholar
Marsiglio W, Greer RA. A gender analysis of older men’s sexuality: social, psychological and biological dimensions. In: Thompson EH, ed. Older Men’s Lives. Thousand Oaks, Calif: Sage Publications; 1994:122–40.Google Scholar
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54–61.PubMedGoogle Scholar
Schiavi RC, Mandeli J, Schreiner-Engel P. Sexual satisfaction in healthy aging men. J Sex Marital Ther. 1994;20(1):3–13.PubMedGoogle Scholar
Talcott J, Rieker P, Propert K, Clark J, Kantoff P. Long-term complications of treatment for early prostate cancer: 2-year followup in a prospective, multi-institutional outcomes study. Proc Am Soc Clin Oncol. 1996;5:252.Google Scholar
Glaser BG, Strauss AL. The Discovery of Grounded Theory; Strategies for Qualitative Research. Observations. Chicago: Aldine Pub. Co; 1967.Google Scholar
Mishler EG, Clark JA, Ingelfinger J, Simon MP. The language of attentive patient care: a comparison of two medical interviews. J Gen Intern Med. 1989;4(4):325–35.PubMedCrossRefGoogle Scholar
Crawford ED, Bennett CL, Stone NN, et al. Comparison of perspectives on prostate cancer: analyses of survey data. Urology. 1997;50(3):366–72.PubMedCrossRefGoogle Scholar
Zinreich ES, Derogatis LR, Herpst J, Auvil G, Piantadosi S, Order SE. Pretreatment evaluation of sexual function in patients with adenocarcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1990;19(4):1001–4.PubMedGoogle Scholar
Charmaz K. Identity dilemmas of chronically ill men. In: Sabo DF, Gordon D, Men’s Studies Association (U.S.), eds. Men’s Health and Illness: Gender, Power, and the Body. Thousand Oaks, Calif: Sage Publications; 1995:266–89.Google Scholar
Frank AW. The Wounded Storyteller: Body, Illness, and Ethics. Chicago, Ill: University of Chicago Press; 1995.Google Scholar