In Prostate Cancer, Sexual Function Correlates With QOL

NEW YORK—Erectile dysfunction is a significant factor in decreasing the quality of life (QOL) of prostate cancer patients, according to a report at the Pan American Congress of Psychosocial & Behavioral Oncology.

“I think a lot of people question the importance of sexual functioning for men with prostate cancer,” said Constance G. Bacon, MS, EdM, a doctoral candidate in health and social behavior at the Harvard School of Public Health. “Typically, this is because the disease is one that occurs in older men and also because these patients may be dealing with a number of other symptoms related to urinary and bowel function that affect quality of life.” Recent research provides evidence, however, that sexual function is a major concern for prostate cancer patients, she said.

As project director of the Quality of Life and Prostate Cancer substudy of the Health Professionals Follow-up Study, Ms. Bacon presented preliminary data on sexual function in a cohort of men who have been followed longitudinally since 1986 in research examining risk factors for heart disease and cancer.

Her substudy identified 827 patients treated for localized prostate cancer between 1993 and 1998 among the 51,529 enrollees in the larger study. All have been receiving questionnaires every 2 years.

The 1992 questionnaire asked about the frequency of ejaculation. “That’s sort of a proxy for their overall sexual functioning,” Ms. Bacon said. Prior to developing cancer, she found “virtually no difference” in the frequency of ejaculation between the prostate cancer patients and age-matched healthy men. The mean age in both groups was 71 years in 1998.

After the cancer diagnosis and treatment, overall sexual functioning of men with cancer was significantly lower than for healthy men.

The 1998 questionnaire asked about quality of life and sexual function. Of the prostate cancer patients, Ms. Bacon reported, 45% said they have used some form of treatment for erectile dysfunction, and many reported that they used more than one type.

The most common was oral medications such as silden-afil (Viagra), used by 25% of the patients. Penile injections, vacuum suction devices, MUSE (alprostadil) suppositories, and surgical implants were also used. Regardless of the type of therapy, patients who used some form of treatment reported better sexual function than those who were not using any treatment, Ms. Bacon said.

The Next Question

“The next question was, ‘How does this affect general quality of life?’” she said. An assessment of quality of life, using a 36-item measurement, revealed consistent correlation of sexual and physical functioning, Ms. Bacon reported.

From the lowest quintile to the highest, she noted, “as you go up in sexual functioning, it’s associated with higher levels of the quality-of-life assessment on the physical component.”

On the mental component of the quality-of-life assessment, the correlation with sexual function was a little less straightforward, Ms. Bacon noted. “But for those men who are using some type of treatment,” she said, “there seems to be a pretty steep increase in their mental quality of life at higher levels of sexual functioning.”