Couple Counseling and Pelvic Floor Muscle Training for Men Operated for Prostate Cancer and for Their Female Partners: Results From the Randomized ProCan Trial

Randi V Karlsen; Pernille E Bidstrup; Annamaria Giraldi; Helle Hvarness; Per Bagi; Susanne Vahr Lauridsen; Vanna Albieri; Marie Frederiksen; Eva Krause; Ulla Due; Christoffer Johansen

doi:10.1016/j.esxm.2021.100350

Couple Counseling and Pelvic Floor Muscle Training for Men Operated for Prostate Cancer and for Their Female Partners: Results From the Randomized ProCan Trial

Sex Med. 2021 Jun;9(3):100350. doi: 10.1016/j.esxm.2021.100350. Epub 2021 Jun 3.

Authors

Affiliations

¹ Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark. Electronic address: randi@cancer.dk.
² Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.
³ Sexological Clinic, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁴ Urological Department, Rigshospitalet, Copenhagen, Denmark.
⁵ Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark.
⁶ Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen, Denmark.
⁷ Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte University Hospital, Herlev, Denmark.
⁸ Department of Oncology, Finsen Centre 5073, Rigshospitalet, Copenhagen, Denmark; Social Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.

Abstract

Introduction: Patients with prostate cancer (PC) who undergo radical prostatectomy (RP) experience impaired sexual and urinary function.

Aim: To compare the effect of early couple counseling and pelvic floor muscle training (PFMT) with usual care for sexual and urinary dysfunction after RP.

Methods: The ProCan study was a randomized controlled trial (RCT) with two parallel treatment arms and 1:1 allocation. Between January 2016 and December 2017, candidates for RP were invited to a longitudinal questionnaire study and provided baseline measures before surgery. Patients who underwent RP, had a female partner, and were sexually active were invited to the ProCan RCT. Couples who provided informed consent were allocated to usual care or usual care and up to six couple counseling sessions, up to three instructions in PFMT and a video home-training program. All couples filled in follow-up questionnaires at 8 and 12 months and non-participants provided 12 months' follow-up. Linear mixed-effect models and 95% confidence intervals were used to measure effects of the intervention.

Main outcome measure: Primary outcome was erectile function, measured with The International Index of Erectile Function, at 8 and 12 months follow-up. Secondary outcomes were sexual and urinary function and use of treatment for erectile dysfunction (ED) by patients; sexual function in female partners; and relationship function, health-related quality of life, anxiety, depression, and self-efficacy in both patients and female partners.

Results: Thirty-five couples were randomized. No significant effect of the intervention was found on erectile function at 8 months (estimated difference in change, 1.41; 95% CI; -5.51 ; 8.33) or 12 months (estimated difference in change, 0.53; 95% CI; -5.94; 6.99) or in secondary outcomes, except for significantly increased use of ED treatment at 8 months.

Conclusion: We found no effect of early couple counseling and PFMT, possibly because of the limited number of participants. Karlsen RV, Bidstrup PE, Giraldi A, et al. Couple Counseling and Pelvic Floor Muscle Training for Men Operated for Prostate Cancer and for Their Female Partners. Results From the Randomized ProCan Trial. Sex Med 2021;9:100350.

Keywords: Couple Counseling; Pelvic Floor Muscle; Physiotherapy; Prostate Cancer; Sexual Dysfunction; Surgery.