Expectations and realities: are we really helping couples to cope post-treatment?


A recent review in the journal Translational Andrology and Urology, which is reprinted on line on the Medscape Oncology web site, addresses the issue of “Couples-based interventions following prostate cancer treatment.” In other words, it deals with how we try to help couples function — with a particular focus on intimacy and sexual activities — after one of the partners has been treated with at least first-line, curative therapy for potentially localized prostate cancer.

The full text of the article by Nelson et al. can be reviewed on the Medscape Oncology web site. For non-members of Medscape, here’s a link to the paper’s abstract.

The fundamental finding of the review, which is based on a close analysis of the six major studies completed in this area to date, is that nothing we are currently offering either the patient or the partner is necessarily helping a lot, and that

Interventions based on innovative theoretical approaches as well as study designs that address the outlined methodological limitations are needed in this area.

This probably isn’t going to come as a big shock to most patients or their spouses/partners. It would be a truism to say that not only do most couples not get offered a great deal of meaningful guidance about how to cope with these problems after a patient has been treated. What is worse, for a lot of patients and their partners, there is only minimal accurate information provided ahead of time about what they may be facing after treatment, and so expectations are often not being well managed.

What the review does make clear is that the patient himself can sometimes be helped to recover some degree of erectile/sexual functionality if this doesn’t recur naturally, and that partners can be helped through interventions designed to address some of the relational issues. However, to your sitemaster, this sounds like we are dealing with the tip of the iceberg at best.

The relationships between couples are extremely complex and learned behaviors have commonly developed over many years. Anne Katz, in a recent CureTalk program (“Changes and challenges in life after prostate cancer“), gave a wonderful example of a very strong relationship between a specific couple that was pretty much destroyed by the patient’s surgery because that relationship was so strongly dependent on their use of “make up” intercourse at night — after they had fought with each other like cat and dog through most of the day. After his treatment, they went on fighting during the day … but there was no opportunity to “make up” properly again at night.

There is a desperate need for new ways to be able to better address the problems caused by loss of intimacy associated with treatment for localized prostate cancer, and there is also a desperate need for couples to be taught to understand that over-treatment for low-risk prostate cancer can lead to social and intimacy consequences that they never really imagined. The loss of closeness and interpersonal connection that can result from the physical and mental frustrations and anxieties associated with erectile dysfunction may — for many — actually be far more devastating than any consequences associated with expectant management for low-risk disease.

6 Responses

  1. As a mentor to prostate cancer patients and their wives/partners, I try to address this issue by providing them information I have compiled over the years regarding erectile dysfunction, the recognition by the patient that there is more to this issue than just himself, and intimacy challenges. I also provide papers addressing incontinence.

  2. Chuck:

    The problem is that the majority of men and their spouses never get to people like you or me (let alone Anne Katz) until long after the ball has been dropped and the damage done. And even we have very limited options to draw on.

  3. Low risk may be one thing, but when the big prostate cancer is coming on like gangbusters, your real choice is probably sex or death. Although one wishes all the fun would last forever, it doesn’t under practically all circumstances. (I guess unless you are a descendant of Tommy Manville; he conceived his last child at age 81.)

    So at the end of the day your job is to ‘man up’ and make the best deal you can.

  4. Dear Natron:

    Actually, as Anne Katz and some others have been pointing out for years, for the majority of men diagnosed today with most forms of prostate cancer, the real choice is not about sex vs. death at all. It is about how to come to terms with a “different” way to “be a man” if one decides one needs to have treatment. See here. The biggest problem many men face is they don’t immediately appreciate that and they may never be advised well about this reality.

    Of course if one is diagnosed with high-risk or metastatic prostate cancer that is quite certainly going to progress if not treated aggressively, then, for some men, there may be a sex vs. death decision, but they are a minority.

  5. there is also a desperate need for couples to be taught to understand that over-treatment for low-risk prostate cancer can lead to social and intimacy consequences that they never really imagined

    Of course, as your omission makes clear, there is no similar need for doctors to be taught to understand that over-treatment for low-risk prostate cancer can lead to those problems. Your omission makes it clear that there is not and hasn’t been any such problem with doctors.

  6. I still mourn the demise of my sex life and my marriage. It’s been over 3 years since my “husband” (or, more accurately, roommate) and I had sex. I’m so lonely that most of the time I don’t care one bit how many years I have left. It feels like there is simply nothing in my life that matters.

    So, great job doctors. You cured my husband but wrecked our lives.

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