Can sexual dysfunction due to prostate cancer treatments be improved with exercise?

Exercise appears to help improve sexual dysfunction in patients with prostate cancer—with or without psychosexual therapy. At least, this was the finding reported by researchers from Australia in a poster presented at the recent annual conference of the American Society of Clinical Oncology (ASCO). Sexual dysfunction is a common consequence of the treatments for prostate cancer and may be associated with various sequelae such as depression. “Exercise is emerging as a potential therapy in the management of sexual health,” the poster stated. But, there are still unanswered questions pertaining to its impact on sexual health in this particular disease. The same researchers have published a variety of studies in the past investigating exercise's effects on men with prostate cancer. In one of the first studies published in 2006, 10 men on androgen deprivation therapy for localized prostate cancer underwent progressive resistance training for 20 weeks. The study showed that exercise improved general muscle strength, functional performance, and balance. Since then, this and other groups have established that both aerobic and resistance exercise improve many physical and mental health outcomes, including strength, body composition, bone mineral density, decreased glucose, fatigue, and cognitive decline. The impact of exercise on sexual health, libido, and sexual performance and satisfaction has been less clear. In an exploratory study in 2022 the team found that exercise was associated with an increased production of myokines, tumor-supressing proteins. The study was of prostate cancer patients using androgen deprivation therapy, but potential clinical significance or other contributing factors is not yet known. Other studies in the literature also support the idea that aerobic exercise may contribute to improving conditions such as erectile dysfunction, likely via its effects on metabolism and cardiovascular health. But few looked specifically at prostate cancer. In an earlier study published in 2022, a 12-week exercise program did not enhance sexual health in 28 patients with bone metastases compared to 29 treated with usual care, showing more needs to be understood about the role of exercise. The current study evaluated a 6-month supervised exercise program and added self-managed psychosexual therapy in one arm, hypothesizing that this combination would show benefit. In this trial, 112 men, all with sexual dysfunction after treatment for prostate cancer, were randomized to exercise with or without psychosexual therapy or usual care. This newer study investigated the effects of supervised, resistance and aerobic exercise with and without self-managed psychosexual therapy on the sexual health in men with prostate cancer. The researchers were not available for interviews. The parallel group, multi-center randomized clinical trial conducted between 2014 and 2018 included 112 participants with prostate cancer who were either undergoing treatment, or had been treated before. They were all experiencing sexual dysfunction. They were randomized to one of three groups for a total of six months of interventions. The first consisted of 39 participants who underwent supervised, group-based resistance and aerobic exercise; the second consisted of 36 who received the same exercise program plus psychosexual therapy; and the remaining 37 underwent usual care. Subjects in the exercise arms went to exercise sessions three days a week. Psychosexual therapy consisted of a self-management intervention that addressed psychological and sexual well-being. The researchers did not respond to interview requests. The primary outcome was sexual health, assessed with the International Index of Erectile Function. Overall, it was found erectile function increased by 5.1 points with exercise and 1.0 point with usual care. Satisfaction with intercourse increased by 2.2 points with exercise and 0.2 points with usual care. Adding self-managed psychosexual therapy into the mix did not result in additional improvements. The study showed that exercise also prevented increased fat mass, improved physical function outcomes, and increased upper and lower body muscle strength. “While exercise is a potent ‘medicine’ for prostate cancer patients and should be strongly encouraged, further evaluation is warranted with respect to the benefit on sexual health,” according to Dr. Celestia Higano. She was not part of the study but was a member of an independent panel that published international guidelines on the sexual health care of prostate cancer patients. She is an adjunct professor of medicine in the Department of Urologic Sciences at the University of British Columbia and the Medical Director of the Prostate Cancer Supportive Care (PCSC) Program. Attention to sexual health should be central to prostate cancer patients' care, yet it is woefully lacking – not just in Canada but globally, she told the Medical Post in an interview. More resources and training of healthcare professionals in this area are needed, as well as help for patients that is accessible regardless of where they live. “There is a huge unmet need,” she said. Indeed, about 81% to 93% of patients report that prostate cancer treatment negatively affects their sex lives, with 20% and 58% of men saying that as a result, sexual activity with their partner ceases—both surgical and radiation treatment impact sexual dysfunction. And there are sequelae of sexual dysfunction. Their sense of self-worth, masculinity, body image, and closeness with one’s partner are all negatively affected. “These changes are extremely distressing,” Dr. Higano said. The guidelines state, “National origin, ethnicity, and race all can affect perspectives on gender roles, sexual orientation, relationships, and health beliefs. Plus, grief and mourning as they relate to sexual loss affect couples’ recovery of sexual intimacy.” The guidelines recommend assessment of sexual dysfunction and distress, screening, the role of psychosexual counseling, helping patients and their partners have realistic expectations for recovery, lifestyle modifications, treatments, and more. In B.C., the PCSC program has successfully supported prostate cancer patients in the province and across Canada, Dr. Higano said. It has online modules and other information to help patients and their families learn more about the disease, its treatment, and interventions. Specifically, there are modules on sexual health and exercise in addition to other offerings. Exercise should be strongly recommended for all prostate cancer patients, whether or not it improves sexual dysfunction, she said.

Can sexual dysfunction due to prostate cancer treatments be improved with exercise?

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