Penile CancerTreatment-Seeking, Aspects of Sexual Activity and Life Satisfaction in Men with Laser-Treated Penile Carcinoma
Introduction
The incidence of penile carcinoma in Sweden is 1.5–2 per 100,000 men per year. It mainly occurs in elderly men; mean age at diagnosis in Sweden is 67 yr [1].
The gold standard therapy has for decades been partial or total penectomy. This treatment is often followed by major side-effects that impact on sexual function and quality of life [2]. Since organ-sparing laser techniques were introduced in the 1980s, the results on localised disease have been promising, with excellent preservation of the penis as well as local disease control that are equivalent with conventional treatments [3], [4], [5], [6], [7], [8], [9].
The rarity of the disease makes it difficult to perform randomised trials, and we know little about the psychosexual factors involved in patients’ perception of the first symptoms and about the time frame in treatment seeking. Studies exploring patient's psychosexual distress and quality-of-life issues generally include small samples with different treatment modalities [2], [10], [11].
We have previously shown that 65% of those who had been sexually active before laser treatment resumed their sexual activities with small reductions in sexual function and satisfaction [12].
The primary objectives of this study were to assess the initial clinical symptoms of penile carcinoma, assess the time between initial symptoms and treatment seeking, and describe the effect of laser treatment of penile carcinoma on sexual activity and life satisfaction.
Section snippets
Methods
The study cohort has been previously described in detail [12] and consisted of a consecutive series of 67 patients referred to the Department of Urology, Örebro University Hospital, Örebro, Sweden, for laser-treatment of penile carcinoma from 1986 to 2000. Fifty-eight of these were alive when this retrospective study was initiated; 46 (79%) of them agreed to participate. Twelve declined to participate; they did not differ significantly from those who participated with regards to age, tumour
Results
Thirty-six (78%)of 46 patients had a steady partner relationship: 31 of these had the same partner as before treatment, whereas 5 had changed his partner after treatment. All reported being heterosexual.
Patient characteristics are presented in Table 1.
Discussion
Hence, men who received laser treatment for localised penile carcinoma coped well with nearly all aspects of life afterwards and resumed their sexual activity to a large extent. These men, as a group, achieved their goals in life concerning life as a whole and most domains of life at a level comparable to the general Swedish male population. One domain in which they failed to reach their goals to a significant extent was that of health.
The investigation suffers from some possible limitations.
Conclusions
To a considerable extent depending upon having or not having a partner, many Swedish men who observe the first symptoms of penile carcinoma often delay seeking treatment. Men who received laser treatment for localised penile carcinoma resumed their sexual activities to a great extent, and experienced levels of satisfaction with sexual life and with most other aspects of life that are equal to those of the general male population aged 34–74 yr. Laser treatment is thus an excellent treatment
Conflicts of interest
The authors have nothing to disclose.
Acknowledgement
This study was supported by grants from Maud and Birger Gustavssons Foundation.
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