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The present analysis explores whether demographic, psychosocial, or intervention adherence factors moderated treatment efficacy of Finding My Way (FMW), an efficacious self-directed web-based psychosocial program for newly diagnosed curatively treated cancer patients. Participants (n = 191) completed a 6-module intervention (n = 94) or attention-control (n = 97) program. Outcome measures were completed at baseline (T0), post-program (T1), 3-month (T2), and 6-month (T3) follow ups. Age, gender, social support, information processing style (monitoring vs blunting), emotion-regulation difficulties, and intervention adherence were examined as potential moderators. Age moderated emotional functioning and general distress at T3 with significant intervention benefits only observed in younger participants; age moderated cognitive functioning at T1, with intervention benefits only found in older participants. Gender moderated helplessness/hopelessness, emotional functioning, and cognitive avoidance at T1 with men benefitting more from receiving the intervention vs control. Monitoring information-processing style moderated cancer distress and anxious preoccupation at T3: higher monitors benefitted more from receiving the intervention vs control. Program adherence moderated global QOL, emotional functioning and social functioning at T2 and T3; cognitive avoidance (T1), anxious preoccupation (T2) and role function (T3), with those who completed more of the program benefitting more if they received the intervention than control. Emotion dysregulation and social support each moderated role function at T2, with those more dysregulated and less socially supported benefitting more if they received the intervention than control. For select outcomes, FMW is more effective for patients with specific characteristics; these findings can inform future tailoring and targeting of online programs for cancer-distress.

IntroductionFear of cancer recurrence (FCR) is a common condition among cancer survivors that can lead to significant levels of distress, anxiety and depression. Online mindfulness programmes may provide the mechanism to support cancer survivors manage FCR and distress, and improve people’s well-being over the short, medium and long term. The primary aim of this study is to determine the potential efficacy of MindOnLine, a 9 session mindfulness-based programme for survivors of breast, prostate and colorectal cancer. A formal economic programme will also be conducted.Methods and analysisA single-blind randomised controlled trial to determine the efficacy and cost-efficacy of a MindOnLine programme for cancer survivors. A total of 400 people living with cancer will be recruited via online advertisements on social media platforms, peak consumer advocacy groups or through outpatient services at healthcare providers across Victoria, Australia. People will be randomly allocated to either the MindOnLine programme (n=200) or waitlist control (n=200). Participant assessments will occur at baseline, at 9 weeks and 9-month follow-up. The primary outcome is change in Fear of Recurrence Index Score total score between baseline and 9 weeks; secondary outcomes are changes in depression and anxiety, quality of life and mindfulness. The economic analysis comprises a cost-consequences analysis where all outcomes will be compared with costs.Ethics and disseminationEthics approval was obtained from the Peter MacCallum Cancer Centre (20-53) and Deakin University (2020-284). All participants will be required to provide written informed consent. Findings will be disseminated in peer reviewed journals and among key stakeholder organisations including hospitals, cancer and community organisations and Government. If successful the project will be rolled out nationally with a formal implementation plan.Trial registration numberAustralian New Zealand Clinical Trials Registry (12620000645954); Pre-results. Registered 6 June 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379520&isReview=true.

There is little research assessing the impact of providing men with information about prostate cancer (PCa) treatment options at the time of referral for a prostate biopsy. Study objectives were to determine whether receiving an information booklet about PCa treatment options prior to receiving biopsy results was acceptable to patients, and if receiving this information influenced levels of anxiety, depression, distress, and treatment decisional conflict. Between June 2016 and September 2017, a randomised block design was used to allocate patients from an Australian urology practice into the intervention or control group. Patients in the intervention group were provided with written information about treatment options for localised PCa prior to their biopsy. Outcome measures including the Distress Thermometer, Generalised Anxiety Disorder-7, Patient Health Questionnaire-9, and Decisional Conflict Scale were completed pre-biopsy and 2–3 weeks post-biopsy. Ninety-eight patients referred for an initial prostate biopsy for an elevated PSA test or suspicious digital rectal exam participated in the study (response rate = 78%). Multimodal repeated-measures analyses showed no significant differences between control and intervention groups in changes in distress, anxiety, or depression from pre- to post-biopsy, and in decisional conflict post-diagnosis (all p > .05). Thirty-five (87%) patients believed that the resource made it easier to understand subsequent explanation of treatment options, and 51 patients (98%) who received the intervention preferred to be given information at that time. Providing patients with information about treatment options prior to biopsy did not impact on changes in psychological distress and decisional conflict post-biopsy. However, the majority of patients preferred to be given such information at this time point.

Purpose: This multicentre randomised controlled trial examined the efficacy of Finding My Way (FMW), a 6-week/6-module online self-guided psychotherapeutic intervention for newly diagnosed curatively treated cancer survivors, in reducing cancer-related distress and improving quality of life compared to an online attention control. Methods: Participants were randomised on a 1:1 ratio using a gender-stratified block design to intervention (n = 94) or attention control (n = 97), and were blinded to condition. Assessments were completed at baseline (T0), post-intervention (T1), 3 months (T2), and 6 months (T3) post-intervention. Mixed model repeated measures analyses examined differences between groups for cancer-specific distress (primary outcome) and general distress, quality of life (QoL), coping, and health service utilisation (secondary outcomes). Results: While both groups reported reduced cancer-specific and general distress over time, between-group differences were not significant. Intervention participants reported lower total health service utilisation and supportive care utilisation post-intervention than controls (total HS use: between-group mean difference = − 1.07 (− 1.85 to − 0.28); supportive care use: between-group mean difference = − 0.64 (− 1.21 to − 0.06)) and significantly higher emotional functioning at 3 months (between-group mean difference = 7.04 (0.15 to 13.9)). At 6 months, the supportive care utilisation finding reversed (between-group mean difference = 0.78 points (0.19 to 1.37). Across remaining QoL and coping outcomes, no significant group differences emerged. Conclusions: While both groups experienced reductions in distress, between-group differences were not significant. This contrasts with the significantly improved emotional functioning observed in FMW participants at 3 months and the short-term reductions in health service utilisation. Long-term increases in supportive care service utilisation suggest FMW only met needs while being actively used. Trial registration: ACTRN12613000001796; http://www.ANZCTR.org.au/ACTRN12613000001796.aspx.

Objective To investigate whether there are any differences in prostate cancer-specific QoL measures at baseline and at 12-months post-surgery between partnered and unpartnered men having robot-assisted radical prostatectomy (RARP) for localised prostate cancer. Methods We investigated differences in patient-reported outcomes using the Expanded Prostate cancer Index Composite-26 (EPIC-26) and the Clark et al. Prostate Cancer Quality of Life Scales. Results Five hundred and forty patients were eligible for this study, 56 of whom were unpartnered. We found few differences between partnered and unpartnered men in terms of patient-reported quality of life outcomes following RARP. In our sample of patients with a high socio-economic status, partnered men had lower 12-month postoperative EPIC sexual domain scores and clinical T-stage and were more likely to be sexually active preoperatively. Overall, our data show that men having RARP for prostate cancer have low sexual confidence, high PSA concern and a low outlook at 12-months post-RARP, irrespective of partnership status. Conclusion The findings of this study suggest that the RARP patient could benefit from a healthcare system that assesses patient sexual outcome following prostatectomy beyond potency and ability to penetrate a partner. By remaining cognisant of other domains such as sexual intimacy, sexual confidence, masculine self-esteem, health worry, PSA concern, outlook and treatment regret, nursing staff may be able to benefit the prostatectomy patient. Where deficits in these domains are observed by the nurse, referral for specialist psychological review could be made. Whether this could work to improve sexual outcomes in men following RARP deserves further investigation.

Background Penile prosthesis surgery is last-line treatment to regaining erectile function after radical prostatectomy (RP) for localized prostate cancer. Aims To assess quality of life, psychological functioning, and treatment satisfaction of men who underwent penile implantation after RP; the psychosocial correlates of treatment satisfaction and sexual function after surgery; and the relation between patients’ and partners’ ratings of treatment satisfaction. Methods 98 consecutive patients who underwent penile implantation after RP from 2010 and 2015 and their partners were invited to complete a series of measures at a single time point. Of these, 71 patients and 43 partners completed measures assessing sexual function, psychological functioning, and treatment satisfaction. Proportions of patients who demonstrated good sexual function and satisfaction with treatment and clinical levels of anxiety and depression were calculated. Hierarchical regression analyses were conducted to determine psychosocial factors associated with patient treatment satisfaction and sexual function and patient-partner differences in treatment satisfaction. Outcomes Patients completed the Expanded Prostate Cancer Index Composite Short Form (EPIC-26), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), Prostate Cancer-Related Quality of Life Scale, Self-Esteem and Relationship Questionnaire (SEAR), Generalized Anxiety Disorder–7 (GAD-7), and Patient Health Questionnaire–9 (PHQ-9). Partners completed the GAD-7, PHQ-9, EDITS (partner version), and SEAR. Results 94% of men reported satisfaction with treatment (EDITS score > 50). 77% of men reported good sexual function (EPIC-26 score > 60). Lower depression scores were associated with higher sexual confidence and sexual intimacy, and these were correlated with better treatment satisfaction and sexual function. Patients experienced higher sexual relationship satisfaction (median score = 90.6) than their partners (median score = 81.2), but there was no difference in treatment satisfaction between groups. Higher patient treatment satisfaction was more likely to be reported for couples whose depression scores were more similar. Clinical Implications It is important to provide preoperative penile implant counseling and encourage patients to seek postoperative counseling if needed. Strengths and Limitations This is one of the first Australian-based studies comprehensively assessing treatment satisfaction and psychosocial health of men after penile prosthesis surgery after RP. This was a retrospective cross-sectional study, so there is a possibility of recall bias, and causal associations could not be determined. Conclusion Men in this Australian series who underwent penile prosthesis surgery after RP generally reported good sexual function and treatment satisfaction. Nevertheless, patient and partner mental health influenced their reported experience of the treatment.

Masculine beliefs are influential in men’s responses to illness; however, current measures of masculinity may not be salient for highly prevalent chronic diseases such as prostate cancer. To address this gap, a contextualized measure of masculinity for men with prostate cancer was developed. A novel measure of masculinity, the Masculinity in Chronic Disease Inventory (MCD-I), was developed based on existing qualitative data and tested for acceptability and face validity with 19 men previously treated for prostate cancer. A cross-sectional survey of 403 Australian men with prostate cancer (Mage = 70.34 years; SD = 7.25) then assessed convergent, divergent, and discriminant validity for the MCD-I using existing reliable and valid measures of masculinity, masculine self-esteem, quality of life, erectile dysfunction, and sexual help seeking. A 6-factor structure for the MCD-I (22 items) was confirmed with good to excellent internal reliabilities (alpha = 0.69–0.92) for the subscale domains of Strength, Sexual Importance/Priority; Family Responsibilities; Emotional Self-Reliance; Optimistic Capacity; and Action Approach. Acceptable convergent and divergent validity was supported, and the MCD-I was also able to discriminate between men with severe versus moderate to mild erectile dysfunction (p = .002) and the Sexual Importance/Priority domain discriminated between men who had sought sexual advice and those who had not (p = .005). A contextual approach to measuring masculinity in men with prostate cancer may help avoid reductionist approaches for focusing on erectile dysfunction in these populations. This also presents a way forward for gender-sensitive psychosocial services and programs for men experiencing prostate cancer. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Background Conducting regular multidisciplinary team (MDT) meetings requires significant investment of time and finances. It is thus important to assess the empirical benefits of such practice. A systematic review was conducted to evaluate the literature regarding the impact of MDT meetings on patient assessment, management and outcomes in oncology settings. Methods Relevant studies were identified by searching OVID MEDLINE, PsycINFO, and EMBASE databases from 1995 to April 2015, using the keywords: multidisciplinary team meeting * OR multidisciplinary discussion * OR multidisciplinary conference * OR case review meeting * OR multidisciplinary care forum * OR multidisciplinary tumour board * OR case conference * OR case discussion * AND oncology OR cancer . Studies were included if they assessed measurable outcomes, and used a comparison group and/or a pre- and post-test design. Results Twenty-seven articles met inclusion criteria. There was limited evidence for improved survival outcomes of patients discussed at MDT meetings. Between 4% and 45% of patients discussed at MDT meetings experienced changes in diagnostic reports following the meeting. Patients discussed at MDT meetings were more likely to receive more accurate and complete pre-operative staging, and neo-adjuvant/adjuvant treatment. Quality of studies was affected by selection bias and the use of historical cohorts impacted study quality. Conclusions MDT meetings impact upon patient assessment and management practices. However, there was little evidence indicating that MDT meetings resulted in improvements in clinical outcomes. Future research should assess the impact of MDT meetings on patient satisfaction and quality of life, as well as, rates of cross-referral between disciplines.

Background Prostate cancer (PCa) poses many emotional and physical challenges for men following treatment. The unmet support needs of these men are well documented, and access to psychosocial support remains problematic. Objectives To assess the efficacy of an online psychological intervention for men who have localised PCa. Design, setting, and participants We undertook a randomised controlled trial to evaluate the intervention. Participants were randomly allocated to one of three conditions: My Road Ahead (MRA) alone (MRA Only), MRA plus access to an online forum (MRA+Forum), and access to the forum alone (Forum). Intervention The intervention was a 10-week self-guided online psychological intervention called My Road Ahead that consisted of six themed modules designed to facilitate improved emotional well-being in the context of PCa as well as a moderated peer forum. Outcome measurements and statistical analysis Pre- and postintervention assessments of psychological distress (the 21-question Depression, Anxiety and Stress Scale) [1] and the Prostate Cancer–related Quality of Life scale [2] were conducted. Multivariate analysis of variance, regression, and structural equation modelling were used to analyse the data. Results and limitations In total, 142 participants were randomly allocated to one of the three intervention arms. The mean age of participants was 61 yr of age (standard deviation: 7), and 88% had undergone radical prostatectomy. A significant improvement in psychological distress was observed for participants who had access to the combined condition (MRA+Forum) with a moderate effect size ( p =0.02; partial η 2 =0.07). In particular, the decline in the mean level of psychological distress was 8.8 units larger for the MRA+Forum group than the Forum group (95% confidence interval [CI], 0.9–16.7). Although the decline in the mean level of psychological distress was 7.0 units larger for the MRA+Forum group than for the MRA Only group, this difference was not significant (95% CI, 1.1–15.1). Structural equation modelling indicated that reductions in health worry and regret contributed significantly to the reductions in psychological distress for the MRA+Forum condition. Conclusions This study is the first, to our knowledge, that has evaluated a self-guided online psychological intervention tailored to the specific needs of men who have PCa. The findings of this study indicate the potential for this programme to deliver support that men may not otherwise receive. Patient summary This study found that men who have localised prostate cancer who received access to the online psychological intervention called My Road Ahead combined with the online peer discussion forum had significantly improved reductions in distress compared with those who received access to the online intervention alone or the forum alone.

6th Annual Scientific Meeting of the Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Redefining Personalised Medicine.

Prue Cormie*, John L. Oliffe, Addie C. Wootten, Daniel A. Galvao, Robert U. Newton and Suzanne K. Chambers Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, WA, Australia School of Nursing, University of British Columbia, Vancouver, BC, Canada Department of Urology, Royal Melbourne Hospital, Parkville, VIC, Australia Epworth Prostate Centre, Epworth Healthcare, Richmond, VIC, Australia Australian Prostate Cancer Research, East Melbourne, VIC, Australia The University of Hong Kong, Hong Kong, Hong Kong UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia Griffith Health Institute, Griffith University, Southport, QLD, Australia Cancer Council Queensland, Brisbane, QLD, Australia Prostate Cancer Foundation of Australia, Sydney, Australia

Objective In the past decade, localised prostate cancer (LPC) management has been shifting from three radical treatment options (radical prostatectomy, external beam radiotherapy, or brachytherapy) to also include active surveillance (AS). This study examines men with LPC and partners' experiences of choosing between AS and radical treatments, and their experiences of AS when selected. Methods A qualitative descriptive research design was used. Interviewed participants were men, and partners of men, who either had chosen radical treatment immediately following diagnosis or had been on AS for at least 3 months. AS was the recommended treatment. Transcribed interviews were thematically analysed and inter-rater reliability integrated. Results Twenty-one men and 14 partners participated. Treatment decisions reflected varied reactions to prostate cancer information, regularly described as contradictory, confusing, and stressful. Men and partners commonly misunderstood AS but could describe monitoring procedures. Partners often held the perception that they were also on AS. Men and partners usually coped with AS but were sometimes encumbered by treatment decision-making memories, painful biopsies, ongoing conflicting information, and unanswered medical questions. Radical treatment was selected when cancer progression was feared or medically indicated. Some preferred doctors to select treatments. Conclusions To reduce distress frequently experienced by men diagnosed with LPC and their partners during treatment decision making and ongoing AS monitoring, the following are needed: improved community and medical awareness of AS; consistent information about when radical treatment is required; and consistent, unbiased information on treatment options, prognostic indicators, and side effects. Regularly updated decisional support information/aids incorporating men's values are imperative. Copyright © 2014 John Wiley & Sons, Ltd.

Objective To examine the effectiveness of a cognitive–behavioural therapy (CBT) group intervention to facilitate improved psycho-sexual adjustment to treatment side effects in prostate cancer survivors post-radical prostatectomy. Methods A randomised, wait-list controlled trial was conducted with a total of 60 men who participated in a manualised 8-week cognitive–behavioural group intervention 6 months to 5 years post-radical prostatectomy for localised prostate cancer. Participants completed standardised questionnaires pre-intervention and post-intervention, which assessed mood state, stress, general and prostate cancer anxiety, quality of life and areas of sexual functioning. Results Paired samples t-tests identified a significant improvement in sexual confidence, masculine self-esteem, sexual drive/relationship and a significant decline in sexual behaviour from pre-intervention to post-intervention. Hierarchical regression analyses revealed that after controlling for covariates, participation in the group intervention significantly improved sexual confidence, sexual intimacy, masculine self-esteem and satisfaction with orgasm. Conclusions This group-based CBT intervention for men post-radical prostatectomy for localised prostate cancer shows promising results in terms of improving quality of life. Copyright © 2013 John Wiley & Sons, Ltd.

e-TC is an online intervention designed to address common psychosocial concerns of testicular cancer survivors. It aims to reduce anxiety, depression and fear of cancer recurrence by providing evidence-based information and psychological intervention. This paper details the development and pilot testing of e-TC. During pilot testing, 25 men (with varying psychological profiles) who had completed treatment for testicular cancer, 6 months to 5 years ago (which had not recurred), used e-TC over a 10-week period and provided quantitative and qualitative feedback on the feasibility and acceptability of the programme. Six men also completed a qualitative interview to provide detailed feedback on their experiences using e-TC. Fourteen men (56%) completed at least 80% of the programme. Participants reported a high level of satisfaction with the programme. Men's limited time was a barrier to programme use and completion, and participants suggested that men with a more recent diagnosis and a higher level of distress may be more likely to engage with the programme. e-TC appears to be a feasible and acceptable online intervention for survivors of testicular cancer. Findings from this study are currently being used to refine e-TC and guide the design of a larger efficacy study. Refereed/Peer-reviewed

Objective To investigate in a prospective, observational study whether transperineal prostate biopsy (TPbx) results in patient-reported quality-of-life (QoL) changes from baseline in the first 3-months after TPbx. Patients and methods Consenting patients completed the 26-item Expanded Prostate cancer Index Composite (EPIC-26), the Sexual Health Inventory for Men, the International Prostate Symptom Score, the Generalised Anxiety Disorder seven-item scale, the Patient Health Questionnaire nine-item scale, and a global question about willingness to have a repeat TPbx in a years' time. The instruments were scored using published scoring methods. Wilcoxon signed–rank tests and Mann–Whitney U-tests were used to investigate statistically significant differences. Clinically significant differences were also investigated defined by published minimal important differences for the EPIC-26 and changes in established categorical groups for the other instruments. Results In all, 53 patients consented to participate and completed the baseline questionnaire, in addition to at least one of the 1- or 3-month follow-up questionnaires. We found that most patients having a TPbx had no clinically significant change in QoL in the first 3 months after TPbx. However, 24% had clinically worse urinary function and 18% had worse sexual function at 1 month. At 3 months, 3% of patients had clinically worse urinary function and 25% continued to have worse sexual function compared with baseline. Patients who were subsequently diagnosed with cancer based on the results of the TPbx, had statistically significantly reduced QoL for the EPIC-26 urinary scales and reduced improvements in scores on the psychological scales at the 1-month follow-up compared with those who were not diagnosed with cancer. Conclusions Most patients having a TPbx had no clinically significant change in QoL in the first 3 months after TPbx. However, patients should be advised that a quarter may have clinically worse urinary function and nearly 20% have clinically worse sexual function in the first month, and that sexual function deficits may continue up to 3 months. The results of this study provide a resource that the clinician can use when discussing TPbx with patients.

The impact that cancer and its treatments can have on sexual functioning, sexual desire, and sexual arousal can be profound and many patients report significant unmet needs in relation to managing sexual difficulties. We reviewed the literature to understand the application of Internet-based technology in the delivery of psychosexual interventions, information provision, and support.Ten studies were identified that utilized Internet-based technology to deliver information, support, or psychosexual interventions designed to improve sexual outcomes, sexual distress, and quality of life of cancer survivors. The intensity of intervention, approach, and complexity differed substantially across platforms.The review identified a range of intervention types designed to enhance sexual outcomes following the challenges that many individuals face after cancer diagnosis and treatment. It is evident that the use of online technology in improving sexual outcomes in cancer care is still in its infancy; however, there is emerging evidence to support the delivery of psychosexual care using the online environment. Further research, using larger, more well controlled methodologies, is required to confirm that sexual outcomes can be improved through the use of online interventions.

Introduction Although sexual dysfunction is common after prostate cancer, men's decisions to seek help for sexual concerns are not well understood. Aim Describe predictors of actual prior help-seeking and intended future medical help-seeking for sexual dysfunction in prostate cancer survivors. Methods A cross-sectional survey of 510 prostate cancer survivors assessed masculine beliefs, attitudes, support/approval from partner/peer networks (subjective norm), and perceived control as predictors of medical help-seeking for sexual concerns. A theory of planned behavior (TPB) perspective was used to examine actual prior and planned future behavior and contributing factors. Statistical analyses included multiple and logistic regressions. Main Outcome Measures Intention to see a doctor for sexual advice or help in the next 6 months was measured using the intention subscale adapted from the Attitudes to Seeking Help after Cancer Scale. Prior help-seeking was measured with a dichotomous yes/no scale created for the study. Results Men were Mage 71.69 years (SD = 7.71); 7.54 years (SD = 4.68) post-diagnosis; received treatment(s) (58.1% radical prostatectomy; 47.1% radiation therapy; 29.4% hormonal ablation); 81.4% reported severe ED (IIED 0–6) and 18.6% moderate–mild ED (IIED 7–24). Overall, 30% had sought sexual help in the past 6 months, and 24% intended to seek help in the following 6 months. Prior help-seeking was less frequent among men with severe ED. Sexual help-seeking intentions were associated with lower education, prior sexual help-seeking, sexual importance/ priority, emotional self-reliance, positive attitude, and subjective norm (R2 = 0.56). Conclusion The TPB has utility as a theoretical framework to understand prostate cancer survivors' sexual help-seeking decisions and may inform development of more effective interventions. Masculine beliefs were highly salient. Men who were more emotionally self-reliant and attributed greater importance to sex formed stronger help-seeking intentions. Subjective norm contributed most strongly to help-seeking intentions suggesting that health professionals/partners/peers have a key role as support mechanisms and components of psycho-sexual interventions.

Aim: To assess the degree of residual urinary and sexual dysfunction experienced by patients treated for localized prostate cancer with radical prostatectomy (RP), external beam radiotherapy (EBRT) or EBRT plus hormone therapy (EBRT/HT) in an Australian sample. Methods: This was a cross-sectional survey of 150 patients who had undergone treatment for localized prostate cancer a mean of 4.93 years prior to the study. It was part of a larger study investigating the psychological adjustment of patients and their partners. Fifty-five patients had undergone RP, 67 patients had undergone EBRT and 28 patients had undergone EBRT/HT for localized prostate cancer. The patients completed the University of California Los Angeles-prostate cancer index to determine the level of residual sexual and urinary dysfunction and bother as well as their socio-demographic characteristics. Results: In the RP group, 34.5% of patients reported urinary leakage every day. Only one RP patient (1.8%) reported this as a significant problem. Inability to achieve an erection was reported by 41.8% of the RP group, 34.3% of the EBRT group and 46.4% of the EBRT/HT group. ancova indicated a significant difference in mean urinary function scores across treatment groups. The RP group showed significantly worse urinary function compared to the other treatment groups; however, this was not perceived to be a significant problem by most of the survivors. Age was significantly associated with sexual function. Conclusion: Patients treated for localized prostate cancer face a high probability of living with long-term residual symptoms. The results of this study suggest that urinary and sexual dysfunction is still evident, even in patients treated more than 4 years ago. The findings are consistent with a growing body of research indicating that patients in the later stages of surviving cancer face significant quality of life issues.

Various conflicting guidelines and recommendations about prostate cancer screening and early detection have left both clinicians and their patients quite confused. At the Prostate Cancer World Congress held in Melbourne in August 2013, a multidisciplinary group of the world's leading experts in this area gathered together and generated this set of consensus statements to bring some clarity to this confusion. The five consensus statements provide clear guidance for clinicians counselling their patients about the early detection of prostate cancer.

Objective To educate a clinical audience of what the specific meaning of the term “validated questionnaire” means from a research methodology perspective when used in a journal article or a conference presentation. Methods To emphasize what is meant by the term “validated questionnaire,” we reviewed the most commonly used prostate-specific, patient-reported, outcome assessment instruments and discuss which have been appropriately validated for use in patients having surgery for localized prostate cancer. Results Not all the prostate-specific instruments used to assess outcomes after surgical treatment for localized prostate cancer have been validated for use in this population. In particular, the Sexual Health Inventory for Men and the International Prostate Symptom Score–American Urological Association-7, which are commonly used by clinicians to measure potency and urinary function, respectively, have not been validated for use in a population of patients having surgery for localized prostate cancer. Conclusion Although patient-reported outcome assessment instruments are frequently used in the urologic literature, little consideration has been given to ensure that users understand why a questionnaire must be validated and what the term “validated” actually means from a research methodology perspective when used in this context. Whether an instrument displays appropriate measurement properties is not a fixed attribute but is dependent on the context and population being studied. Studies using questionnaires that have not been validated in the population of interest may be subject to measurement error, and any conclusions drawn cannot be made with total confidence. Clinicians should consider this when reading journal articles and designing study protocols.

Background There is a need for psychosocial interventions for men with prostate cancer to promote adaptive coping with the challenges and distress associated with diagnosis, treatment and recovery. In addition, interventions are needed that help to overcome barriers to psychosocial treatment such as limited face-to-face psychosocial support services, a shortage of adequately trained professionals, geographical distance, perceived and personal stigma and a preference for consumer-centric and self-directed learning. My Road Ahead is an online cognitive behaviour therapy (CBT) intervention for prostate cancer. This protocol describes a randomised controlled trial (RCT) that will evaluate the efficacy of this online intervention alone, the intervention in combination with a moderated online forum, and the moderated online forum alone. Methods/design This study utilises a RCT design with three groups receiving: 1) the 6-module My Road Ahead intervention alone; 2) the My Road Ahead intervention plus a moderated online forum; and 3) the moderated online forum alone. It is expected that 150 men with localised prostate cancer will be recruited into the RCT. Online measures will assess men’s psychological distress as well as sexual and relationship adjustment at baseline, post-intervention, 3 month follow-up and 6 month follow-up. The study is being conducted in Australia and participants will be recruited from April 2012 to Feb 2014. The primary aim of this study is to evaluate the efficacy of My Road Ahead in reducing psychological distress. Discussion To our knowledge, My Road Ahead is the first self-directed online psychological intervention developed for men who have been treated for localised prostate cancer. The RCT will assess the efficacy of this intervention in improving psychological well-being, sexual satisfaction, relationship satisfaction and overall quality of life. If successful, this intervention could provide much needed support to men receiving treatment for localised prostate cancer in a highly accessible manner. Trial registration Australian New Zealand Clinical Trials Registry Identifier: ACTRN12611000278932

Various conflicting guidelines and recommendations about prostate cancer screening and early detection have left both clinicians and their patients quite confused. At the Prostate Cancer World Congress held in Melbourne in August 2013, a multidisciplinary group of the world's leading experts in this area gathered together and generated this set of consensus statements to bring some clarity to this confusion. The five consensus statements provide clear guidance for clinicians counselling their patients about the early detection of prostate cancer.

Prostate cancer poses many challenges for both the man and his partner. Partners have reported a range of issues that impact their own mental health following their partner’s diagnosis of prostate cancer. The aim of this review is to summarise and critically evaluate the current literature reporting psychosocial intervention studies for partners of prostate cancer patients. An extensive literature search of electronic databases was conducted (OvidMEDLINE 1946, 26th September 2013, and psychINFO 1967, 26th September 2013) using the keywords prostate cancer AND intervention* OR therapy* OR psychosocial intervention* OR support* AND couple* or Spouse* or Partner* or Intimate partner* matched to the title as well as secondary scanning of reference lists. Studies were included if they described interventions for partners of prostate cancer patients, either solely for the partners or as a couple, intended to alleviate distress and enhance the partner’s or couple’s quality of life, and reported a measurable outcome for partners. A total of 11 prostate cancer-specific intervention studies that included partners and reported separate results for the partners were found. Only one of these interventions was partner specific, the other eight involved the patient-partner dyad. The studies identified primarily focussed on two areas: emotional distress and sexual intimacy, and mixed findings were reported for efficacy of interventions. Despite strong evidence that partners of men with prostate cancer experience difficulties associated with the impact of prostate cancer, there is limited research that has investigated the efficacy of psychosocial interventions for partners. Of the reviewed studies, it is evident that interventions targeting the reduction of emotional distress, improved communication and sexual intimacy between the couple and utilisation of strategies that enable partners to express their distress, learn new strategies and implement behavioural change show the most promising results in enhancing partner well-being. Significant progress is required in developing and evaluating appropriate and effective psychosocial support interventions for partners of prostate cancer survivors as partners appear to have significant unmet needs in this area.

The role of the General Practitioner (GP) in testing for and managing men with prostate cancer (PCa) is significant. Very few studies have explored the attitudes and practices of Australian GPs in the context of the role of PCa testing. In this study, a 46-item web-based questionnaire was used to assess self-reported PCa testing attitudes and practices of GPs. This questionnaire was circulated to divisions of general practice and Medicare locals for further distribution to their GP members across Australia. GPs from all states and territories participated, and a total of 136 GPs completed the survey. Of the responding GPs, 57% always or usually offered PCa testing to asymptomatic men ≤70 years of age and 60% of GPs always or usually included a digital rectal examination (DRE). Many (80%) of the GPs stated that the current PCa testing guidelines were not clear. PCa testing was offered opportunistically by 56% while 39% offered testing at the patient’s request. The results captured in this study represent a snapshot of GP attitudes and practices from across Australia. The results presented indicate a wide variation in the approaches to PCa testing in general practice across Australia, which in most part appear to be related to the lack of clarity of the current prostate cancer testing guidelines.

This chapter will provide an overview of the psychosocial impact of prostate cancer across the different phases of the disease, including the point of diagnosis, the treatment decision-making phase, post-treatment, and advanced disease. The impact on partners and intimate relationships is also considered. Masculinity is discussed in relation to the mechanisms by which this construct shapes the way men adjust to the experiences of prostate cancer, in particular erectile dysfunction and incontinence. Psychological support interventions are discussed across each of these phases of disease.

Introduction Although previous research has evaluated the effectiveness of psychosocial interventions for men with prostate cancer, no previous review has investigated the effects of psychosocial interventions on both sexual and relationship functioning. Aim To review the effectiveness of psychosocial interventions that focus on sexual and/or relationship functioning for men with prostate cancer and their partners. Method A systematic literature review of research reported in the Medline, PsychINFO, PsychArticles databases from January 1990 to September 10, 2011. Main Outcome Measure The review focused on the evaluation of interventions that aimed to improve the sexual and/or relationship functioning of men and their partners. Results There was evidence that psychosocial interventions can improve men's sexual functioning, particularly when delivered face‐to‐face and when using more complex strategies to target sexuality in men and in relationships. There was inconclusive evidence for the effectiveness of psychosocial interventions in improving men's relationship functioning or the sexual or relationship functioning of their partners. Conclusions There is a need for further research to target improving and measuring men and their partner's sexual and relationship functioning in the context of prostate cancer. The effectiveness of tailoring interventions to the specific needs of men and to their stage of cancer also needs to be further examined. Chisholm KE, McCabe MP, Wootten AC, and Abbott J‐AM. Review: Psychosocial interventions addressing sexual or relationship functioning in men with prostate cancer. J Sex Med 2012;9:1246–1260.

This study aims to explore the experiences of patients enrolled in a cancer-related clinical drug treatment trial utilising a qualitative focus-group methodology. Specifically, this study aimed to explore the impact of social and family support, the challenges and advantages of taking part in a clinical trial and the experiences of patients at the conclusion of the trial.A qualitative study was conducted at a public hospital in Melbourne in 2008. A total of 14 participants were recruited. Three focus groups and two interviews were conducted with 13 patients who had completed a cancer-related clinical trial. Comments from a letter written by a trial participant were also analysed. Interviews were audio-recorded, transcribed and coded according to emerging themes.Information obtained was grouped around four main themes; making sense of trial participation, challenges of treatment in the context of clinical trial participation, support during trial participation and coping with trial conclusion. Participants experienced a mixture of hope, uncertainty and apprehension as they considered whether to take part in a clinical trial. At different stages of the trial they made sense of their participation by thinking about the possible benefits of participation. Trial participation was also associated with a number of emotional and practical challenges. Generally, participants were very positive about the support they received from health professionals, family and friends. The end of the trial was associated with a mix of emotions, including relief, disappointment, hope of future help, uncertainty and abandonment.Clinical trial participation is a positive experience for many patients with cancer, although there are a number of associated practical and emotional challenges. Trial participants may benefit from closer follow-up from clinical trial staff, especially the treating doctor, assessment of support needs and help in re-evaluating the meaning of their trial participation if their initial hopes and expectations are not met.

Objectives: The aim of this study was to identify the factors that contribute to psychological adjustment in prostate cancer patients two or more years post-treatment. Method: One hundred and sixty-seven men who had undergone treatment for localised prostate cancer participated in this study. In the sample 63 participants had undergone external beam radiotherapy (EBRT), 55 radical prostatectomy (RP), 27 EBRT plus hormone therapy (EBRT/HT), and the remainder a combination of treatments. Patients completed the UCLA-PCI, the POMS, CISS, DAS and a threat appraisal questionnaire. Results: The majority of patients reported relatively positive adjustment in most domains except sexual functioning. For those who reported ongoing psychological difficulty mood disturbance was associated with sexual bother, dyadic adjustment, threat appraisal, self-efficacy appraisal and emotion-focussed coping. Lower levels of urinary bother were associated with the use of more task-focussed coping. Emotion-focussed coping and threat appraisal mediated the relationship between sexual bother and mood disturbance. Emotion-focussed coping moderated the influence of dyadic adjustment on mood disturbance. Conclusions: Dyadic adjustment, threat appraisal and coping style play a significant role in the long-term psychological adjustment of prostate cancer patients. The results of the current study indicate that the use of emotion-focussed coping to manage sexual bother appears to result in poor psychological adjustment, which indicates the need for further education or intervention to manage sexual dysfunction. Ethics Clearance: Human ethics approval was granted from Southern Health, Peter MacCallum Cancer Centre and the Monash University Ethics Committee before commencement of data collection. Copyright © 2007 John Wiley & Sons, Ltd.

Men with prostate cancer are not routinely offered psychosocial support despite strong evidence that being diagnosed with prostate cancer poses significant quality of life concerns and places the patient at elevated risk of developing a range of mental health disorders. The objective of this study was to develop an online psychological intervention for men with prostate cancer and to pilot test the feasibility and acceptability of the intervention. Development of the intervention involved a multidisciplinary collaboration, adapting face-to-face and group intervention strategies for an online format. The full online intervention and moderated forum were pilot tested with 64 participants who were recruited from urology practices in Melbourne, Victoria, Australia. After consenting to participate and creating a personal account in the online programme, participants completed baseline demographic questionnaires. Participants were provided access to the programme for 6–12 weeks. After completing the programme participants completed an online survey to assess intervention and forum utilisation and satisfaction, as well as suggest intervention refinements following their use of the intervention. Patient satisfaction was calculated using mean responses to the satisfaction questionnaire. The intervention was received positively with 47.82% of participants highly satisfied with the programme, and 78.26% said they would recommend it to a friend. Participants' qualitative feedback indicated good acceptability of the online intervention. A number of technical and participant engagement issues were identified and changes recommended as a result of the feasibility testing.