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Objectives: To evaluate the readiness of couples to engage in a sexual rehabilitation programme (SRP) before radical prostatectomy (RP) and to identify barriers to participation in an SRP after RP. To identify couples' current levels of sexual function and intimacy., Patients and Methods: Patients completed the International Index of Erectile Function (IIEF) and their partners completed the Female Sexual Function Index (FSFI) to measure sexual function. Couples completed the Miller Social Intimacy Scale (MSIS) to measure intimacy in relationships. All participants were seen by a sexual health clinician after completing the measures to discuss barriers to participation in an SRP, and to receive an education session., Results: Study participants comprised 143 patients and 104 partners. Patients <60 years old had significantly higher sexual function (P < 0.002) compared with those patients aged 60 years and older. Partners' sexual function scores were suggestive of need for further medical evaluation. Partners' participation was cited by patients as important to them enrolling in an SRP. Couples' intimacy levels were strongly correlated (P < 0.0001)., Conclusions: Results suggest that less than 50% of patients are interested in receiving information about the impact of RP on sexual function before surgery. Female sexual function should be assessed as part of any SRP because they may require medical treatment if they are to support rehabilitation efforts for their spouses. Baseline assessment of a couple's sexual function and willingness to participate in an SRP should be performed preoperatively., (© 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.)

Unlabelled: What's known on the subject? and What does the study add? Active surveillance is a management strategy that offers patients the hope of avoiding the side effects associated with unnecessary treatment. This study identifies the resources required by men who choose to be on active surveillance to support them in their treatment decision., Objectives: •  To examine the decision-making processes of men on active surveillance (AS). •  To identify the resources that men want to access to make, support and sustain them while on AS., Patients and Methods: •  Three-part survey developed for this study based on a qualitative study of 25 men on AS. •  Survey items explored: role men assumed with their physician in treatment decision-making, factors influencing decision to go on AS, and resources required while on AS. •  Surveys mailed out to cross-sectional sample of men on AS for less than 10 years., Results: •  27% of the 73 men reported assuming an active role in treatment decision-making with their urologist, 41% a shared role and 32% a passive role. •  82% of men reported being comfortable and 90% being satisfied with their decision to be on AS. •  55% reported not being anxious about the cancer progressing while on AS. •  Urologist's opinion, current age, and impact of treatment on urinary function were main factors influencing treatment decision. •  Information on future treatment options, non-traditional treatments and diet considered most important resources., Conclusions: •  Results suggest that once men make a decision to go on AS, they are satisfied with their decision and few report being anxious about progression of cancer. •  Men are strongly influenced by the treating specialist in taking up AS. •  Additional information and psychological support resources are required for men on AS., (© 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.)

Objective: To identify factors that patients with prostate cancer believe to be important determinants in their decisions about future enrolment in clinical trials., Patients and Methods: In all, 122 patients (within 5 years of a diagnosis of prostate cancer) who had never been asked to participate in a clinical trial were asked to complete a 30-item measure of 'Factors Influencing Participation' in clinical trials., Results: Factor analysis showed that variables influencing participation can be grouped into three areas: acceptability (e.g. recruitment process and altruistic beliefs); awareness (e.g. impact on quality of life, survivorship and randomization process); and accessibility (e.g. costs to patient, influence of family, age, time and need for extra tests). Awareness items were rated significantly more important by patients with T1 or T2 disease (P = 0.002). Patients who had not made a treatment decision also rated awareness (P = 0.05) and acceptability (P = 0.04) items higher. Patients with less than a university education identified access items as more important (P = 0.03). Helping future patients with prostate cancer, the impact of the study protocol on survival, being fully informed about the study, relationship with specialists, and impact of study on quality of life were identified as the five variables having the most influence on future enrolment., Conclusions: Men rated items related to awareness and acceptability as being the most important determinants to future enrolment in a clinical trial. Knowledge about what these men believe is important for their future participation in a clinical trial will help researchers to design protocols that address the needs of targeted patient groups.

Objective: To examine the effect of changes in quality of life (QoL) and levels of sexual function on decisional regret after surgical treatment of localized prostate cancer., Patients and Methods: Patients who decided to have a radical prostatectomy (RP) were assessed for health-related QoL using the general European Organization for Research and Treatment of Cancer C30 instrument and disease-specific prostate cancer module, and sexual function using the abbreviated International Index of Erectile Function-5 before and 1 year after RP. Decision control was measured before RP, and decisional regret 1 year afterward, using measures mailed to participants 1 year after treatment., Results: Of 130 respondents (mean age 62 years), 4% expressed regret over their decision to have surgery. Physical and social functioning, and finances, were compromised, while emotional functioning and treatment-related symptoms improved by 1 year. Higher levels of decisional regret were correlated with decreases in role and social functioning, increased pain and financial difficulty (all P < 0.01). Sexual function was decreased (P < 0.001) after treatment. Men reported feeling less masculine, having less sexual enjoyment, difficulty in getting and maintaining an erection, and discomfort when being sexually intimate after surgery. Mean scores of decisional regret were similar among patients who reported assuming either active (84%) or collaborative (11%) roles in treatment decision-making. Men who assumed a passive role reported the most variability and highest scores on decision regret., Conclusions: Few men regretted having RP at 1 year after treatment, even though some QoL functions and domains were significantly affected. Ongoing assessment of the effect of surgical treatment on sexual function, sexuality and masculinity certainly deserves further exploration with this group of cancer survivors.

Objective: To evaluate a sexual rehabilitation service for men with prostate cancer and to use these results to inform the development of future care., Patients and Methods: The study participants included 155 men with prostate cancer referred to a sexual rehabilitation clinic by their urologists or radiation oncologists, of whom the partners of 58 were in attendance. Questionnaires to measure sexual function and positive feelings towards the partner were completed before the clinic visit; and for satisfaction with the clinic service immediately after the appointment; and for sexual function, positive feelings towards the partner, and satisfaction with treatments at 4 months afterward., Results: Ninety patients completed the 4-month evaluation, of whom 35 were couples. Enhancement of erection and understanding sexual changes related to treatment were the two main concerns of patients. Phosphodiesterase-5 inhibitors and intracavernosal injections were the treatments of choice. Compared with partners, patients had significantly greater positive feelings towards their partners at both measurement times and were more satisfied with their prescribed treatment. The total scores on sexual function were significantly higher at 4 months., Conclusions: These results support the need to include partners as a necessary part of these men's sexual rehabilitation. A structured follow-up is necessary to monitor the success of treatment and to document the quality of erection.