How GPs can support men with prostate cancer

Dr Anna Gavin explains the findings of the Life After Prostate Cancer Diagnosis study and what it means for how GPs and other health professionals can best support patients.

(Photo: monkeybusinessimages/Getty Images)
(Photo: monkeybusinessimages/Getty Images)

Prostate cancer is the most common cancer in men, with around 400,000 men living after a diagnosis in the UK.

The Life After Prostate Cancer Diagnosis study funded by the Movember Foundation in partnership with Prostate Cancer UK is the country’s largest ever patient-reported outcomes study for the disease. It involved over 30,000 men and bringing together researchers from the University of Leeds, Queen’s University Belfast, University of Southampton and Oxford Brookes University with Public Health England.1

By publishing our full findings,2 we want to give healthcare professionals across the country the information they need to offer the best care for these men.

What are the biggest issues for men living with prostate cancer?

The research revealed that more than 4 in 5 men with prostate cancer struggle with poor sexual function following treatment for the disease regardless of the stage of their disease,3 their treatment, or their age. Despite this, just over half reported they were not offered help with sexual function, such as medications, devices, or specialist services.

What other issues do these men face?

Men with prostate cancer also reported problems with pain/discomfort, taking part in their usual activities, mobility and anxiety/depression, with just over 60% of men reporting at least one problem in any of these areas.

Men also reported social distress, problems with self-care, maintaining relationships and money matters, although to a lesser degree.

Significantly, men treated with hormones report more problems in all areas.

Men who are not the ‘typical’ patient with prostate cancer – those who are under 65, single, and/or gay, have specific needs for support and information. They can feel marginalised and lonely, and struggle to accept the impact on their sexual relationships, identities and work life.

Younger couples and parents also struggled to manage the impact of their disease on the family and access the support needed.

The box below shows a more detailed breakdown of some of these results.

What support should GPs be offering?

In line with NICE guidelines,4 health professionals should proactively initiate discussions about side effects, including sexual problems, and should signpost men to the appropriate support and information.

Men should have access to specialist erectile dysfunction services should they need them, and may be offered a daily low-dose PDE5 inhibitor tablet to improve their chance of getting erections alongside a range of PDE5 inhibitor tablets to take as and when they want to get an erection.

If this is unsuccessful, or can’t be taken because of other health reasons, men should be offered vacuum devices, topical drugs, or penile prostheses as an alternative.

Health professionals also need to consider providing men with tailored information and support that is relevant to their treatment type, symptoms, age, stage in life, marital status and sexuality.

It may also be helpful to refer these men to external sources of support, such as Prostate Cancer UK’s specialist nurses and online information or an online self-management programme to help improve sexual wellbeing after prostate cancer, funded by the Movember Foundation, which is available here.

Summary

It’s clear from the findings that the side effects from prostate cancer treatments can have a big impact on men’s lives. Some of these side effects can be life changing, challenging and long-lasting or even permanent, so it’s vital that men get support to help them deal with these changes.

With the right support and information, men can find out about treatments or counselling that could help them manage, or come to terms with, sexual problems and other difficulties caused by their cancer experience.

  • Dr Gavin is co-lead investigator of the Life After Prostate Cancer Diagnosis study and clinical reader in public health at Queen’s University Belfast

Sign up to one of Prostate Cancer UK’s free Primary Care Masterclasses here.

Problems experienced by men with prostate cancer

Percentage of men who experienced poor sexual function, by treatment type:

  • Active Surveillance – 51%
  • Watchful waiting – 58%
  • Brachytherapy – 63%
  • Surgery – 84%
  • Surgery + radiotherapy / ADT – 92%
  • Radiotherapy – 79%
  • Radiotherapy + ADT – 88%
  • ADT – 94%
  • Systemic therapy (ie chemotherapy, abiraterone or enzalutamide) + ADT – 98%
  • Systemic therapy (ie chemotherapy, abiraterone or enzalutamide) + radiotherapy +/- ADT – 95%

Percentage of men who experienced poor sexual function, by age:

  • Under 55 years – 54%
  • 55-64 years – 66%
  • 65-74 years – 79%
  • 75-84  years 88%
  • 85+ years – 95%

Other problems

Men most commonly reported problems with:

  • Pain/discomfort – 42%
  • Taking part in their usual activities – 37.7%
  • Mobility – 36.1%
  • Anxiety/depression – 33.6%

They were least likely to report problems with:

  • Self-care – 14.3%

Just over 60% of men reported at least one problem on any of these five domains (62%). Men treated with hormones report more problems in all areas.

Source: Prostate Cancer Outcomes - Life after prostate cancer diagnosis. Results summary.

References

  1. Downing A, Wright P, Hounsome L, et al. Quality of life in men living with advanced and localised prostate cancer in the UK: a population-based study. Lancet Oncol 2019; 20: 436-47.
  2. The full UK-wide data report is available online here: https://tn-openaccess-prod.s3.amazonaws.com/tn_oa_mvp1/media/filer_public/c6/ba/c6bab31b-ce79-44fa-a873-3824eabe1e53/lapcd_results_summary.pdf
  3. Three quarters of men (75%) diagnosed with localised prostate cancer reported poor sexual function, compared with 90.4% of men with locally advanced disease (cancer that has spread to the tissue surrounding the prostate gland), and 96% of men diagnosed with advanced prostate cancer.
  4. NICE. Prostate cancer: diagnosis and management. CG175. January 2014.

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