Increasing prostate cancer incidence (~56% increase since 1991) and survival rates (5-year survival rate increased from ~58% to ~92% since 1987) coupled with an aging population have led to a large and rapidly growing population with unique health care requirements [
1]. Sexual dysfunction is one of the most common, distressing and persistent adverse effects of prostate cancer treatments [
2‐
11] which has a profound impact on quality of life both for the patient and his partner [
2‐
4,
10,
12‐
14]. The level of concern associated with sexual dysfunction is reflected by the willingness of men to sacrifice survival for sexual potency (i.e. 68% of men are willing to sacrifice a ~10% greater advantage in 5-year survival to maintain sexual function) [
15]. Up to 90% of men will experience sexual dysfunction following primary therapy for prostate cancer with treatments frequently leading to erectile dysfunction, loss of libido, penile shortening and altered orgasmic experience [
2‐
11]. Current health care services are inadequate to address the demand for management of sexual dysfunction [
3], with 47% of prostate cancer survivors reporting unmet sexual health care needs [
16]. Management strategies predominately involve pharmacological interventions to address the direct physiological effects of prostate cancer treatment on erectile function [
17,
18]. However, the aetiology of sexual dysfunction is multifaceted and there are considerable physiological and psychological side effects of prostate cancer treatments which contribute to sexual dysfunction that are not counteracted by pharmacological intervention [
3,
4,
10]. Exercise has established efficacy for improving many of these factors in prostate cancer patients including changes in body composition (especially to counteract body feminisation with androgen deprivation therapy [ADT]), fatigue, physical function, risk of co-morbid conditions, inflammatory state, depression, anxiety and quality of life [
19‐
25]. Emerging data indicates that exercise also fosters improved feelings of masculinity and has a positive impact on libido in men with prostate cancer [
26,
27], a concern that is highly prevalent and difficult to treat [
3,
12]. Furthermore, psychological therapies have established efficacy for improving treatment induced psychological changes associated with prostate cancer including depression and anxiety as well as enhanced quality of life [
28‐
31] with emerging evidence for improving sexual health in prostate cancer patients [
32,
33]. Therefore, a multidisciplinary management strategy incorporating pharmacological (usual medical care), physiological (exercise program) and psychological (brief psychosexual self-management) interventions may represent a best-practice model for addressing sexual dysfunction secondary to prostate cancer treatment [
27]. The relatively low uptake, compliance and satisfaction with current treatment options [
34‐
36] coupled with the low help-seeking and health service utilisation behavior of men [
37‐
39] provides additional rationale for the novel management approach proposed. Hence, the aims of this study are to:
1.
Examine the efficacy of exercise as a therapy to aid in the management of sexual dysfunction in men with prostate cancer.
2.
Determine if combining exercise and brief psychosexual self-management results in more pronounced improvements in the sexual health of men with prostate cancer.
3.
Assess if any benefit of exercise and brief psychosexual self-management on sexual dysfunction in men with prostate cancer is sustained long term.
We will evaluate three main hypotheses: 1) Compared with usual medical care, exercise will improve sexual health in men with prostate cancer who are concerned by sexual dysfunction. We theorise that exercise will improve masculine self-esteem, quality of life, psychological distress, fatigue, body composition, body image and physical function, culminating in increased sexual health; 2) When exercise and brief psychosexual self-management are combined, improvements in sexual health will exceed those observed in usual medical care and exercise therapy alone. We theorise that brief psychosexual self-management will further enhance improvements in sexual health through increasing men’s ability to better self-manage their well-being and sexual dysfunction (i.e. enhanced uptake of pharmacologic management of erectile dysfunction); and 3) Improvements in sexual health will be sustained 1 year after completion of the exercise and combined exercise and psychosexual interventions. We hypothesise that the theoretically based interventions will prompt behavioural change that leads to sustained improvements in sexual health.
Despite being a critical survivorship care issue, there is a clear gap in current knowledge of the optimal treatment of sexual dysfunction in men with prostate cancer. The current study will generate information to address this gap. There is a strong theoretical rationale [
27] and emerging evidence [
26] that exercise is an innovative therapy to counteract sexual dysfunction in men with prostate cancer. However, there is a distinct lack of research investigating the efficacy of exercise on sexual health following cancer treatment. Furthermore, despite the multidimensional aetiology of sexual dysfunction, there is a paucity of research investigating the efficacy of integrated treatment models. This study will address these limitations. Findings will expand current clinical guidelines for the management of sexual dysfunction in men with prostate cancer and, importantly, facilitate the development of targeted supportive care services for survivors concerned by their sexual health. Evidence gained may lead to a paradigm shift in the management of sexual dysfunction in prostate cancer survivors.