The Institute of Medicine highlights the distinct need to address sexual dysfunction in cancer survivors. Sexual dysfunction is especially prominent in prostate cancer. Prostate cancer is the most common cancer in men, with approximately 233,000 new cases diagnosed in 2014. A primary side effect of prostate cancer treatment is erectile dysfunction (ED), with as many as 85% of men reporting problems with erections. Men who have ED report significant frustration, increased depressive symptoms, and reduced general happiness with life. Surgery (radical prostatectomy) is a gold standard treatment for early stage prostate cancer, and the medical field has made important advances in treating ED following surgery. The current best practice is the concept of erectile rehabilitation, which helps increase the chance of recovering erections following surgery. However, men have difficulty complying with these programs. Our data suggest that only 10% of men who receive proactive nurse practitioner phone calls are compliant with erectile rehabilitation. We developed a novel intervention designed to increase compliance with an erectile rehabilitation program. This intervention uses Acceptance and Commitment Therapy (ACT) and helps men focus on the long-term goals of rehabilitation, accept the frustration related to ED, identify and overcome barriers, and commit to an erectile rehabilitation program. In our pilot work, a greater percentage of men in the intervention group, compared to a nurse practitioner enhanced monitoring control, adhered to the erectile rehabilitation program (44% vs.10%, p = 0.02). We propose a larger, two arm, RCT to determine if increased compliance in the intervention leads to improved erectile function at 24 months following surgery. One hundred and fifty-five subjects will be randomized to each arm: Arm 1- Standard care plus the ACT intervention; Arm 2 - Standard care plus nurse practitioner enhanced monitoring and education (EME). We believe this intervention is innovative as it: 1) describes a conceptual framework for avoidance of rehabilitation and outlines how this leads to poor compliance, 2) shifts the primary treatment focus from increasing education to reducing avoidance, 3) applies ACT concepts to a sexual-based intervention, 4) integrates a psychological intervention into an erectile rehabilitation program, and 5) proactively focuses on rehabilitation, increasing the chance of recovery and reducing the negative quality-of-life issues related to ED.

Public Health Relevance

Lifesaving prostate cancer treatment can have a high cost to survivors in regard to their sexual health. Prostate cancer is the most common type of cancer in men in the US; over 90% of men are diagnosed in the early stage, and the 5 and 10-year survivor rates are over 90%. Since 85% of men treated for early stage cancer report difficulties with erections, problems with sexual functioning after treatment for prostate cancer impacts hundreds of thousands of prostate cancer survivors. ACT-ED is designed to address this significant survivorship issue by providing a brief intervention to help men adhere to an erectile rehabilitation program following prostate cancer surgery to improve sexual functioning.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Nursing and Related Clinical Sciences Study Section (NRCS)
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St Germain, Diane
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Sloan-Kettering Institute for Cancer Research
New York
United States
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Emanu, Jessica C; Avildsen, Isabelle K; Nelson, Christian J (2016) Erectile dysfunction after radical prostatectomy: prevalence, medical treatments, and psychosocial interventions. Curr Opin Support Palliat Care 10:102-7
Hyde, Melissa K; Zajdlewicz, Leah; Wootten, Addie C et al. (2016) Medical Help-Seeking for Sexual Concerns in Prostate Cancer Survivors. Sex Med 4:e7-e17
Nelson, Christian J; Emanu, Jessica C; Avildsen, Isabelle (2015) Couples-based interventions following prostate cancer treatment: a narrative review. Transl Androl Urol 4:232-42