This presentation provides real, in-depth information from a doctor as well as prostate cancer survivors and their partners. Treatments for prostate cancer carry significant side effects that change many issues.  We recognize that prostate cancer becomes a problem for the survivor and partner. Traditional concepts of masculinity and femininity  often complicate the problem.

1. Prostate Cancer
& Sexuality
Dr. Jo-an Baldwin Peters
BSc MSc PhD

2. Dr. Jo-an Baldwin Peters
BSc MSc PhD
• Feels the fact that treatments for prostate cancer carry
significant side effects that change many issues.
• Recognizes that prostate cancer becomes a problem for
the survivor and partner.
• Understands that traditional concepts of masculinity and
femininity often complicate the problem and the
problem is ignored and not solved.
• Her PhD was completed at the age 69.
• As the wife of a prostate cancer survivor and an
Epidemiologist Jo-an felt that partners, especially
women were left out of the picture.
• Jo-an is staying involved, hopeful that other women will
join her.

3. dr.jo.an.p
@
gmail.com

4. Prostate Cancer Sexuality
Online Survey Results
First Response 19 Oct 2009
Last Response 29 Oct 2010
Survivor Partner
# Questions 65 45
Responses 448 203
Total Responses 651

5. Ven ezu ela Au str a lia
0% 2%
F r a n ce
0% Gr eece
0%
H olla n d
Ca n a d a 0%
19% H u n ga r y
USA
78% 0%
I sr a el
0%
J apan
0%
M on golia
0% Sp a in
Sou th Afr ica 0%
0%
Sw itzer la n d
UK 0%
1%

6. Prostate Cancer Sexuality Survey
448 Survivor Respondent Ages
30 28
Nu m b er o f r esp o n d en t s
25 23
20
15 13
10
5
2 2
0
42 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84
Age a t r esp o n se t im e

7. Prostate Cancer Sexuality Survey
Respondent Reported Treatments
H I FU
Ch e m o 0%
H or m one B r a ch y 2 %
16% 7%
R a dia tion
21%
R obotic Cr yo
AS
14% 2%
2%
R a d i ca l
36%

8. S25. How would you rate your ability to have a
spontaneous erection after treatment for prostate
cancer? Treatments/Time/Age
Respondents answered “Sometimes” or “Always”
Months 3 6 12 18 24 +24 Resps.
Radical prostatectomy 14% 22% 26% 27% 28% 29% 144
Radical retropupic prostatectomy 13% 20% 13% 13% 20% 20% 15
Radical nerve sparing prostatectomy 25% 33% 40% 46% 42% 38% 48
Robotic prostatectomy 16% 19% 22% 22% 27% 21% 73
Radicals All 16% 23% 27% 28% 30% 28% 280
Brachytherapy/seed implants 66% 68% 73% 66% 56% 56% 41
Cryosurgery/Crotherapy 44% 44% 33% 33% 33% 44% 9
External beam radiation 50% 60% 50% 40% 50% 30% 10
Proton beam radiation 100% 60% 60% 60% 60% 60% 5
Radiation Totals 67% 60% 53% 47% 53% 40% 15
Age 50 and less 31% 13% 19% 13% 19% 13% 16
Age 50-60 23% 30% 33% 31% 31% 30% 122
Age 60-70 43% 49% 54% 55% 56% 54% 144
Age 70+ 21% 21% 24% 24% 21% 22% 102

9. S25 P11 How would you rate your partner's ability to
have a spontaneous erection after treatment for prostate
cancer?
80%
70%
60%
50%
40%
30%
20%
10%
0%
Never So m et i m es Al w a ys
SURVIVOR PARTNER
Each category read columns left to right
Within 3, 6, 12, 18, 24 and “more than 24” months

10. S42 S44 P28 P30
Overall how big a problem do you consider your sexual
dysfunction (all respondents)
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
N o p r o b lem Ver y sm a ll Sm a ll M o d er a t e B ig p r o b lem
p r o b lem p r o b lem p r o b lem
Su r vivo r P a r tn er Gu es s F o r Su r vivo r
P a r tn er Su r vivo r Gu es s fo r P a r tn er

11. S23 P13. MATCHED
How important do you think is penetrative sex is?
(Survivor Choice minus Partner Choice)
5
4
3
2
1
0
1
3
5
7
9
11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
41
43
45
47
49
51
53
55
57
59
61
63
-1
-2
-3
-4
-5
D iffer en ce

12. S42 S44 P28 P30
Overall how big a problem do you consider your sexual
dysfunction (all respondents)
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
N o p r o b lem Ver y sm a ll Sm a ll M o d er a t e B ig p r o b lem
p r o b lem p r o b lem p r o b lem
Su r vivo r P a r tn er Gu es s F o r Su r vivo r
P a r tn er Su r vivo r Gu es s fo r P a r tn er

13. S23 P13. MATCHED
How important do you think is penetrative sex is?
(Survivor responded “Very Important”)
30
25
20
15
10
5
0
R esp o n se
So m ew h a t
im p o r t a n t
im p o r t a n t
I m por ta n t
I m por ta n t
im p o r t a n t
N o t ver y
Ver y
Not
No
Months
Su r vivo r P a r tn er Gu es s P a r tn er Su r vivo r Gu es s

14. S25. How would you rate your ability to have a
spontaneous erection after treatment for prostate
cancer? Treatments/Time
Respondents answered “Sometimes” or “Always”
120%
100%
80%
60%
40%
20%
0%
3 6 12 18 24 24+ Months
R a d ica l p r osta tectom y R a d ica l r etr op u p ic p r osta tectom y
R a d ica l n er ve sp a r in g p r osta tectom y R ob otic p r osta tectom y
R a d ica ls All B r a ch yth er a p y/ seed im p la n ts
Cr yosu r ger y/ Cr oth er a p y E xter n a l b ea m r a d ia tion
P r oton b ea m r a d ia tion R a d ia tion T ota ls

15. S25. How would you rate your ability to have a
spontaneous erection after treatment for prostate
cancer? Age/Time
Respondents answered “Sometimes” or “Always”
60%
50%
40%
30%
20%
10%
0% Months
3 6 12 18 24 24+
Age 5 0 a n d les s Age 5 0 -6 0 Age 6 0 -7 0 Age 7 0 +

16. S30 & P16 How important is it to experience an orgasm
on a regular basis even if it does not result from
penetrative sex?
Completed the questions: 94 % Survivors, 86% Partners
70% 60%
60%
50% 42%
40%
30%
20% 8% 8%
10%
0%
No t I m p o r ta n t I m p o r ta n t o r ver y im p o r ta n t
Su r vivo r P a r tn er

17. S33 Which of these forms of assistance resulted in an orgasm with or
without penetration?
Did not Achieved Achieved Achieved
achieve orgasm orgasm most orgasm Response
orgasm infrequently of the time always Count Success Rate
Self masturbation 12 26 85 65 190 94%
Mutual masturbation 7 16 48 25 103 93%
Penile shots 8 8 23 18 59 86%
Oral sex 16 16 31 29 94 83%
Sex toys such as
4 3 9 5 24 81%
vibrators
Penile implant 3 2 5 5 18 80%
Pump 19 16 19 9 68 70%
Oral medication
(provide medication
name in comment 31 18 29 24 113 70%
box below, if
possible)
Other 1 1 1 0 5 67%
Nothing 11 7 6 6 54 63%
Urethral suppositories 8 3 2 2 18 47%

18. S33 Which of these forms of assistance resulted in an orgasm with or
without penetration?
Achieved Achieved
orgasm most orgasm Response
Method of the time always Count Success Rate
Self masturbation 140 108 326 76%
Mutual masturbation 83 49 189 71%
Penile shots 31 29 84 70%
Oral sex 56 43 161 67%
Sex toys such as
16 9 42 63%
vibrators
Penile implant 8 6 21 61%
Pump 28 12 97 56%
Oral medication
(provide medication
51 41 178 52%
name in comment box
below, if possible)
Other 2 0 6 47%
Nothing 6 6 54 41%
Urethral suppositories 2 2 18 33%

19. S33 P19 Which of these forms of assistance resulted in an orgasm with
or without penetration?
(94% PCa Survivors & 86% of Partners answered this Question)
Achieved Achieved
orgasm most orgasm Response Achieved
Method of the time always Count Success Rate Achieved Achieved Response Percentage
Self masturbation 140 108 326 76% 29 39
93 73%
Penile shots 83 49 189 71% 11 8 44
43%
Mutual masturbation 31 29 84 70% 42 37 115
69%
Penile implant 8 6 21 1 3 6
67% 67%
56 43 161 34 32 100
Oral sex 61% 66%
Toys,vibrators,movies 16 9 42 15 15 47
56% 64%
Oral medication 51 41 178 52% 24 14 76
50%
Pump 11 6 40 43% 11 6 40 43%
2 0 6 33% 0 0 2
Other 0%
4 2 18 1 1 8
Urethral Supositories 33% 25%
Nothing 13 12 60 42%
10 3 46 28%

20. Respondent
Comment
Sample
Prostate Cancer
Sexuality
Online Survey

21. • I passed out when I self-injected.
Then we went to Cialis with no
positive result. Now back to
injections, with my wife doing it.
We have not had frequent sex
beause it upsets her to do the
injections and ruins the mood.
Will keep trying

22. • We tend to keep too busy and
have not been concentrating
on sex lately. Levitra almost
works.

23. • The range of time mattered a lot.
It's been over two years. The first
six months there was almost
nothing; now after two years we
can often have enjoyable sex
without Viagra, although we
usually do it with Viagra to be
sure we have the fun we want.

24. • Hard to answer since most of the 12 years were
satisfactory and only recently started hormone
therapy which changed everything. Other issue is
that I am 12 years older so always wonder what
would be the natural course of my potency if I was
not treated or had Prostate Cancer. Once it
metastasizes and survival becomes an issue one's
oersoective on the importance of sex changes. I
wish there were more resources available now to
both my wife and i about achieving intimacy
without intercourse. She does not like to use the
internet for a source.

25. • Some of the implications of these questions appear
to center on whether of not we can have successful
intercourse or not. Many men I believe must reach a
point where they come to peace with the situation.
Is sex more important than life. We also must learn
that our partner, especially nearing age 60 is more
interested in feeling loved, than having rousing
sexual encounters. The intimacy that results when
the man concentrates on the female's needs, and
bringing her to an aroused state and orgasm is a
satisfying sexual encounter for both.

26. • Thanks for being willing to
research this area. For
individuals like me, it's
important to see that there are
others out there that have
similar issues.

27. • Again, I think it is important that
the doctor visit with both husband
and wife. I think my wife may
have been more interested if she
realized that my sexual desires
were normal for a man of my age
(65 ) at the time of surgery.

28. Broaden discussion/presentation topics beyond just PC
treatment and fundamental incontinence and ED
treatments. Emphasize that an active life, including sex, is
quite achievable despite damaged plumbing. Emphasize
that early PC detection is very important--every male
should know this!
My greatest hope is that more doctors will be told that they
must address the subject of sex. If they aren't comfortable
doing this, or don't have the time to do it properly, they
should direct the patient & his partner to a good source of
information. It's sad when the problems are not
understood until they've become established, and the
patient doesn't even know he could have done things to
help with his rehabilitation.
Lack of success achieving penetrative sex has left us with
a failing desire for sex at all. We agreed prior to his
operation 8 years ago that life was more important... it
seems it was so easy to believe that then. We failed to
appreciate how devastating it would be to a relationship.
It's like losing a loved-one; the memory is dear but the loss
tangible.

29. Answers!
Discussion?

30. Thank you!