Sexual characteristics of patients with prostate cancer seen for radiation treatment
Abbas Adus-salam1,2, Mutiu Jimoh1,2 and Chiamaka Godsgift Ehiedu2
1Department of Radiation Oncology, University College Hospital/University of Ibadan, Ibadan 200212, Nigeria
2University College Hospital, Ibadan 200005, Nigeria
Abstract
Background: Prostate cancer was estimated to be the second most diagnosed cancer and the fifth leading cause of cancer mortality among men, with an estimated 1.4 million new cases and 375,000 deaths globally in 2020. There are significant changes in sexual activities and subsequent changes in quality of life associated with the diagnosis and treatment of prostate cancer. Sexual problems experienced by prostate cancer patients include erectile dysfunction, reduced sexual desire, reduced sexual function, problems with ejaculation, as well as problems with orgasm, and these could occur before and/or after treatment. This study aims to highlight the sexual characteristics of prostate cancer patients, which would help identify altered sexuality that might require intervention by healthcare providers.
Method: All patients who presented with pathologically diagnosed, organ-confined prostate cancer referred for high-dose-rate brachytherapy were approached for participation in the study. An interviewer-administered questionnaire was administered to the consenting patients.
Results: A total of 56 patients gave consent for the study out of 60. All the patients were married, with 5 (8.9%) having multiple wives. Only ten respondents (17.9%) reported having other sexual partners besides their wives. More than half of the patients (34) (60.7%) started having sexual intercourse between the ages of 18 and 20. Many patients claimed that the diagnosis of prostate cancer had affected their sexual lives. About half of the respondents (44.6%) believed that their partners were less satisfied with their sexual performance, as evidenced by the loss of partners (5.4%), partners refusing sexual advances (14.3%), partners complaints (10.7%), and partners' reduced inclination to ask for sex (33.9%). One patient expressed fears of passing the disease to their partners.
Conclusion: The management of prostate cancer should include sex therapy and rehabilitation in couples from the point of diagnosis to maintain sexual function as close as possible to that in the general population in order to maintain an improved quality of life.
Keywords: sexual characteristics, prostate cancer, sexual dysfunction
Correspondence to: Mutiu Jimoh
Email: jimohmutiualani@yahoo.com
Published: 20/07/2023
Received: 28/03/2023
Publication costs for this article were supported by ecancer (UK Charity number 1176307).
Copyright: © the authors; licensee ecancermedicalscience. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction
Prostate cancer was estimated to be the second most diagnosed cancer and the fifth leading cause of cancer mortality among men, with an estimated 1.4 million new cases and 375,000 deaths globally in 2020 [1]. In Africa and Nigeria, prostate cancer was estimated to be the most commonly diagnosed malignancy and the leading cause of cancer mortality among men in 2020, with an estimated 93,173 new cases and 47,249 mortalities in Africa and 15,306 new cases and 8,517 mortalities in Nigeria [2, 3]. Nigeria accounted for 16.4% of the new prostate cancer cases and 18% of prostate cancer mortalities in Africa in 2020 [2, 3].
Incidence rates of prostate cancer vary across the world, with the lowest rates in Asia and Northern parts of Africa and the highest rates in The Caribbean, Europe, Australia, New Zealand, Northern America and Southern Africa, while prostate cancer mortality rates are highest in The Caribbean, Sub-Saharan Africa and Micronesia/Polynesia [1]. Some identified risk factors for prostate cancer include increasing age, genetic mutations, family history [1], blacks [4], smoking and being overweight [5].
There are significant changes in sexual activities and subsequent changes in quality of life associated with the diagnosis and treatment of prostate cancer [6]. Sexual problems experienced by prostate cancer patients include erectile dysfunction, reduced sexual desires, reduced sexual function, problems with ejaculation, as well as problems with orgasm, and these could occur before and/or after treatment [7–11]. Sexual dysfunction in prostate cancer patients could result from prostate cancer, prostate cancer treatments, and psychiatric disorders (such as depression, fear, anxiety and psychologic instability) resulting from prostate cancer diagnosis or its treatment [12–14].
Erectile dysfunction is the most extensively studied sexual dysfunction [15] and is defined as consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual activity by a man for ≥3 months [16]. Some studies have shown erectile dysfunction incidence post-radical prostatectomy to be between 20% and 90% [17–19]. Another study revealed the incidence of impotence in previously potent men as 65% after non-nerve-sparing prostatectomy, 58.6% after unilateral nerve-sparing prostatectomy, and 56.0% after bilateral nerve-sparing prostatectomy [20]. The incidence of erectile dysfunction after radiotherapy was reported to be 19%, 28%, 26% and 40% before radiotherapy, on the last day of radiotherapy, 2 months after radiotherapy, and 16 months after radiotherapy, respectively, with radiotherapy dose of 70.2–72Gy [21]. Following high-dose-rate brachytherapy, the incidence of erectile dysfunction was reported to be between 10% and 51%, with a median of 31.5% [22]. A meta-analysis that assessed the rate of erectile dysfunction after treatment for localised prostate cancer revealed the predicted probability of erectile dysfunction after high-dose-rate brachytherapy, external beam radiotherapy, high-dose-rate brachytherapy and external beam radiotherapy, nerve-sparing prostatectomy, radical prostatectomy, and cryotherapy as 24%, 45%, 40%, 66%, 75% and 87%, respectively [23]. Other factors associated with erectile dysfunction include increasing age, hypertension, diabetes mellitus and medications [24–26]. Changes in sexuality affect not only males with prostate cancer but also their partners [27] as both patients and their female partners suffer psychological effects of the diagnosis and treatment of prostate cancer [12, 28, 29].
Preservation of sexual function is important in the management of patients with localised prostate cancer [12] and health professionals need to keep this in mind to ensure better quality of life for prostate cancer patients and their partners [30]. This study aims to highlight the sexual characteristics of prostate cancer patients, which would help identify altered sexuality that might require intervention by healthcare providers. Also, this study will help fill some knowledge gaps, as studies on the sexuality of prostate cancer patients in Nigeria are sparse.
Aims and objectives
The aim of the study is to report on the sexual characteristics of the patients who presented with pathologically diagnosed prostate cancer.
Method
This study is a descriptive cross-sectional study carried out amongst pathologically confirmed, localised prostate cancer patients presenting at the Department of Radiation Oncology, University College Hospital, Ibadan, for high dose rate prostate brachytherapy between August 2020 and April 2022. The study questionnaire (Appendix 1) is made up of two sections administered to study participants with the help of a research assistant who helped in filling and translating medical terms in the study questionnaire for the ease of understanding of participants. All 60 patients seen within this period were approached for the study. However, only 56 patients gave written informed consent for the study. Data were collected from consenting patients with the aid of a questionnaire administered by the researchers. Other necessary clinical information was obtained from the patient’s case notes. The collected data was analysed using SPSS v. 22, and the results were presented in tables and frequencies.
Results
A total of 56 patients gave consent for the study out of 60 patients seen during the period. Their ages ranged from 51 to 79, with a mean age of 66.45 years and a SD of 6.785 (Figure 1). All patients had localised adenocarcinoma of the prostate, with prostate volume ranging between 23 and 96 mLs and prostate-specific antigen (PSA) ranging between 5.8 and 124.5 ng/mL, and were radiation treatment naïve. They all subsequently high dose brachytherapy 27 Gy in 2#. All the patients were married, with 5 (8.9%) having multiple wives. Only ten respondents (17.9%) reported having other sexual partners besides their wives. More than half of the patients (34%, or 60.7%) started having sexual intercourse between the ages of 18 and 20 years. The earliest was 15 (1 patient) years, while 37 years was the most advanced age for first sexual intercourse.
Most of the patients (91.1%) were sexually active prior to the diagnosis of prostate cancer. Only five patients (8.9%) were not sexually active before the diagnosis. Those who are not sexually active increased to 37.5% following the diagnosis (Table 1). Prior to diagnosis, most patients had sex once (20 patients, 35.7%) or twice (22 patients, 39.3%) per week.
Only a few patients (7, 12.5%) reported using sex-enhancing substances like drugs and alcohol. Sildenafil and alcohol were the most popular substances used. Only three patients (5.4%) reported previous oral sex. Another 6 (10.7%) had a previous history of sexually transmitted diseases (STDs), some on multiple occasions. Gonorrhoea was the most commonly diagnosed STD. Others are staphylococcal and herpes infections. There was no history of syphilis among the patients.
Most of the patients knew their HIV status and that of their partners, and they all reported being HIV-negative.
Many patients claimed that the diagnosis of prostate cancer had affected their sexual lives. About half of the respondents (44.6%) believed that their partners were less satisfied with their sexual performance, as evidenced by the loss of partners (5.8%), partners refusing sexual advances (14.3%), partners' complaints (10.7%), and reduced inclination of the patients’ partners for sex (33.9%) (Table 1). One patient expressed fears of passing the disease to their partners.
Figure 1. Age distribution of patients.
Table 1. Occupation, Gleason score, sexual characteristics and sexual impact of prostate cancer diagnosis on patients.
Discussion
This study showed that the mean age of patients with prostate cancer presenting for brachytherapy was 66.45 years (SD: 6.785 years) and the ages ranged from 51 to 79 years. This finding is consistent with those from various studies globally and locally [1, 31–37]. This could be due to the increasing incidence of prostate cancer with increasing age [38]. The diagnosis and treatment of prostate cancer in this age group could constitute additional morbidity, as patients within this age group are at increased risk of having other co-morbidities.
All patients in this study were married. This is similar to the findings of a study carried out in Lagos and another comparative study of clinicopathologic features between Nigerian patients in Abuja and South African patients with prostate cancer. In the Lagos study, all patients were either married (95.1%), separated (2.1%), or widowed (2.8%), while all patients from Nigeria in the comparative study were married [36, 37]. This could be due to sociocultural practices among Nigerians, as the proportion of married men increases with increasing age, as demonstrated by the 2018 national demographic health survey, which showed that over 90% of men between the ages of 40 and 49 were married [39].
Less than a tenth (8.9%) of the patients had multiple wives. The finding is slightly different from that of a study carried out amongst prostate cancer patients in Sokoto State, Nigeria, which showed that about 28.6% of patients were married in a polygamous setting [40]. This could be due to the predominance of Muslims in the Northern part of Nigeria, whose religion permits polygamy with a maximum of four wives [40]. Possible reasons for the preference for monogamy include religious, social and economic reasons [41].
In this study, 17.9% of the patients had sexual partners apart from their wife/wives. This finding is similar to the findings of a case-control study carried out in the United States of America, which showed that 27% of patients with prostate cancer have had sexual intercourse with prostitutes [42]. Extramarital affairs have been shown to have a significant association with younger age, urban residential areas, Yoruba ethnicity, early age of sexual debut, monogamy and higher levels of education [39, 43] and some of these factors could account for the findings in our study.
About three-fifths of the patients had their sexual debut between the ages of 18 and 20, with 15 years being the earliest and 37 years the latest. This finding is in tandem with studies carried out in the United States of America and Turkey, which demonstrated the age of first sexual intercourse among patients with prostate cancer to be 16–19 and 18 ± 6 years, respectively [42, 44]. This could be due to the existing sociocultural practices, as the median age of coitarche in the general population amongst men was revealed to be 21.7 years by the national demographic health survey in Nigeria [39]. Most pre-diagnosis sexual characteristics of patients in this study are almost similar to those of the general population, as shown by the national demographic health survey, and efforts should be made by the healthcare providers to ensure that the changes after diagnosis and treatment are as minimal as possible to ensure optimal quality of life.
The majority (91.1%) of the patients in this study were sexually active prior to diagnosis, and this proportion decreased to 62.5% after diagnosis. Findings similar to this were also made by Albaugh et al [45] who reported that the majority (74%) of the prostate cancer patients did not report erectile dysfunction prior to the diagnosis of prostate cancer while another study reported that 58.7% of patients were sexually active post-treatment [46]. The reduction in sexual activity could be due to factors such as the psychological trauma of diagnosis in both patients and partners, treatment, and the psychological stress of treatment [12–14, 28, 29]. Such a decrease in sexual activity can lead to decreased sexual satisfaction and a subsequent decrease in overall quality of life.
About 75% of the patients who were sexually active in this study had sexual intercourse at least once or twice per week, which is in tandem with the study carried out by Rousseau et al [47] where 80% of the prostate cancer patients had at least one sexual intercourse per week. The finding from this study is also similar to that carried out in the United States of America, which revealed that more than half of the patients with prostate cancer had sexual intercourse about 1–2 times per week [42].
Sex stimulants such as drugs (Sildenafil) and alcohol were used by patients (12.5%) in this study. Phosphodiesterase five inhibitors are part of the treatment options for the management of erectile dysfunction, with an 81% response rate following their use in prostate cancer patients with erectile dysfunction [48]. Alcohol, on the other hand, is seen by many as sex-enhancing, and this is ascribed to its disinhibitory properties [49]. Compared to the proportion of patients with reduced sexual activity, the proportion of patients that used sex enhancers was low, and this could be due to fear of drug interaction with treatment or under-reporting as a result of privacy concerns.
Three patients (5.4%) reported a prior history of oral sex. There is a dearth of literature relating to oral cancers in heterosexual prostate cancer patients. However, a study carried out among men who have sex with men revealed that oral sex was the most frequent form of sexual practice after masturbation [50]. Socio-cultural norms or the unpopularity of oral sex in Nigeria could account for the underreporting of oral sex practices in Nigeria. While there is no literature reporting an association between oral sex and prostate cancer, oral sex has been recommended as a form of sexual activity that can provide sexual pleasure and an avenue to build intimacy amongst partners [51].
Gonorrhoea was the most commonly reported sexually transmitted infection (STI) among 10.7% of patients who had a prior history of STIs. This is similar to a Mexican study that showed that 16.6% of the men reported previous STI, with gonorrhoea being the most common, and that a previous history of gonorrhoea was associated with an increased risk of prostate cancer [52]. The findings in this study were also in tandem with those from the case-control study done in the United States of America, which revealed that about 13% of patients with prostate cancer had a history of previous gonorrhoea infections [42]. Some studies have reported that age at first intercourse, number of sexual partners, and history of gonorrhoea may play a role in the aetiopathogenesis of prostate cancer, while others have demonstrated no association between the above sexual characteristics and prostate cancer [40, 42, 44, 53].
The diagnosis of prostate cancer was reported to affect the sexual lives of most patients. This could be due to psychological stress, fear and anxiety, resulting in altered sexual lives [12–14]. The diagnosis and treatment of prostate cancer can also affect the sexuality of patients’ partners [12, 29–54], and in our study, 44.6% of patients believed that their partners were less satisfied sexually, which led to the reduced inclination for sex by patients partners (33.9%), refusal of sexual advances by patients partners (14.3%), complaints by patients partners (10.7%), and loss of a partner (5.4%). This brings to the fore a need by partners of patients with prostate cancer that needs to be catered for. Significant to note is that one patient’s sexual life was altered due to fear of transmitting prostate cancer to his partner. This highlights the need for proper patient education to prevent altered sexual function and a subsequent decrease in quality of life due to a lack of information.
This study is the first, to the best of our knowledge, to evaluate the sexual characteristics of treatment-naive prostate cancer patients with localised disease in Nigeria. It is, however, limited by the sample size. Further analytical studies with a larger sample size need to be carried out to assess all aspects of sexual dysfunction in prostate cancer patients as well as their partners for prompt pre-emptive management to ensure improved quality of life for prostate cancer patients and their partners.
Conclusion
Prostate cancer is a disease of public health importance due to its burden on society. The diagnosis and treatment of prostate cancer have a significant impact on the sexuality of prostate cancer patients and their partners, with a subsequent impact on their quality of life. Thus, the management of prostate cancer should include sex therapy and rehabilitation in couples from the point of diagnosis to maintain sexual function as close as possible to that in the general population in order to maintain an improved quality of life.
Conflicts of interest
The authors declare no competing interests.
Funding
None.
Consent for publication
All authors agreed on the publication of this manuscript.
Informed consent
Informed consent was obtained from all participants and/or their legal guardians.
Ethical consideration
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of the University College Hospital Ibadan.
Availability of data and materials
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
1. Sung H, Ferlay J, and Siegel RL, et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries CA Cancer J Clin 71 209–249 https://doi.org/10.3322/caac.21660 PMID: 33538338
2. International Agency for Research in Africa Global Cancer Observatory [https://gco.iarc.fr/today/data/factsheets/populations/903-africa-fact-sheets.pdf]
3. International Agency for Research, Nigeria Global Cancer Observatory [https://gco.iarc.fr/today/data/factsheets/populations/566-nigeria-fact-sheets.pdf]
4. Rebbeck TR, Devesa SS, and Chang BL, et al (2013) Global patterns of prostate cancer incidence, aggressiveness, and mortality in men of African descent Prostate Cancer 2013 560857 https://doi.org/10.1155/2013/560857 PMID: 23476788 PMCID: 3583061
5. World Cancer Research Fund/American Institute for cancer research continuous update project expert report 2018 body fat, weight gain, and the risk of cancer [dietandcancerreport.org] Date accessed: 27/10/20
6. Benedict C, Traeger L, and Dahn J, et al (2014) Sexual bother in men with advanced prostate cancer undergoing androgen deprivation therapy J Sex Med 11(10) 2571–2580 https://doi.org/10.1111/jsm.12645 PMID: 25059094
7. Hald GM, Pind MD, and Borre M, et al (2018) Scandinavian prostate cancer patients’ sexual problems and satisfaction with their sex life following anti-cancer treatment Sex Med 6(3) 210–216 https://doi.org/10.1016/j.esxm.2018.06.002
8. Saitz TR, Serefoglu EC, and Trost LW, et al (2013) The pre-treatment prevalence and types of sexual dysfunction among patients diagnosed with prostate cancer Andrology 1 859–863 https://doi.org/10.1111/j.2047-2927.2013.00137.x PMID: 24127273
9. Elliott S and Matthew A (2018) Sexual recovery following prostate cancer: recommendations from two established Canadian sexual rehabilitation clinics Sex Med Rev 6 279–294 https://doi.org/10.1016/j.sxmr.2017.09.001
10. Matsushita K, Tal R, and Mulhall JP (2012) The evolution of orgasmic pain (dysorgasmia) following radical prostatectomy J Sex Med 9 1454–1458 https://doi.org/10.1111/j.1743-6109.2012.02699.x PMID: 22458302
11. Fode M and Snksen J (2014) Sexual function in elderly men receiving androgen deprivation therapy (ADT) Sex Med Rev 2(1) 36–46 https://doi.org/10.1002/smrj.17 PMID: 27784542
12. Hyun JS (2012) Prostate cancer and sexual function World J Mens Health 30(2) 99–107 https://doi.org/10.5534/wjmh.2012.30.2.99
13. Moore TM, Strauss JL, and Herman S, et al (2003) Erectile dysfunction in early, middle, and late adulthood: symptom patterns and psychosocial correlates J Sex Marital Ther 29 381–399 https://doi.org/10.1080/00926230390224756 PMID: 14504009
14. Nelson CJ, Mulhall JP, and Roth AJ (2011) The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer J Sex Med 8 560–566 https://doi.org/10.1111/j.1743-6109.2010.02127.x
15. Benson CR, Serefoglu EC, and Hellstrom WJG (2012) Sexual dysfunction following radical prostatectomy J Androl 33 1143–1154 https://doi.org/10.2164/jandrol.112.016790 PMID: 22744864
16. Dwyer M and Nehra A (2010) Defining sexual function after radical retropubic prostatectomy Urol Oncol 28 469–472 https://doi.org/10.1016/j.urolonc.2010.01.007 PMID: 20451415
17. Litwin MS, Lubeck DP, and Henning JM, et al (1998) Differences in urologist and patient assessments of health-related quality of life in men with prostate cancer: results of the CaPSURE database J Urol 159 1988–1992 https://doi.org/10.1016/S0022-5347(01)63222-1 PMID: 9598504
18. Kawanishi Y, Lee KS, and Kimura K, et al (2001) Effect of radical retropubic prostatectomy on erectile function, evaluated before and after surgery using color doppler ultrasonography and nocturnal penile tumescence monitoring BJU Int 88 244–247 https://doi.org/10.1046/j.1464-410x.2001.02271.x PMID: 11488738
19. Siegel T, Moul JW, and Spevak M, et al (2001) The development of erectile dysfunction in men treated for prostate cancer J Urol 165 430–435 https://doi.org/10.1097/00005392-200102000-00019 PMID: 11176390
20. Stanford JL, Feng Z, and Hamilton AS, et al (2000) Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the prostate cancer outcomes study JAMA 283(3) 354–360 https://doi.org/10.1001/jama.283.3.354 PMID: 10647798
21. Pinkawa M, Gagel B, and Piroth MD, et al (2009) Erectile dysfunction after external beam radiotherapy for prostate cancer Eur Urol 55(1) 227–234 https://doi.org/10.1016/j.eururo.2008.03.026
22. Challapalli A, Jones E, and Harvey C, et al (2012) High-dose rate prostate brachytherapy: an overview of the rationale, experience, and emerging applications in the treatment of prostate cancer Br J Radiol 85(1) S18–S27 https://doi.org/10.1259/bjr/15403217
23. Robinson JW, Moritz S, and Fung T (2002) Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma Int J Radiat Oncol Biol Phys 54(4) 1063–1068 https://doi.org/10.1016/S0360-3016(02)03030-4 PMID: 12419432
24. Schouten BWV, Bohnen AM, and Groenerveld FPMJ, et al (2010) Erectile dysfunction in the community: trends over time in incidence, prevalence, and medicine use J Sex Med 7 2547–2553 https://doi.org/10.1111/j.1743-6109.2010.01849.x PMID: 20497307
25. Montejo AL, Llorca G, and Izquierdo JA, et al (2001) Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients J Clin Psychiatry 62 10–21.
26. Werneke U, Northey S, and Bhugra D (2006) Antidepressants and sexual dysfunction Acta Psychiatr Scand 114 384–397 https://doi.org/10.1111/j.1600-0447.2006.00890.x PMID: 17087787
27. Grondhuis Palacios LA, Krouwel EM, and den Oudsten BL, et al (2018) Suitable sexual health care, according to men with prostate cancer and their partners Support Care Cancer 26(12) 4169–4176 https://doi.org/10.1007/s00520-018-4290-2 PMID: 29876833 PMCID: 6209012
28. Hamilton LD, Van Dam D, and Wassersug RJ (2015) The perspective of prostate cancer patients and patients’ partners on the psychological burden of androgen deprivation and the dyadic adjustment of prostate cancer couples Psycho-Oncology 25 823–831 https://doi.org/10.1002/pon.3930
29. Kornblith AB, Herr HW, and Ofman US, et al (1994) Quality of life of patients with prostate cancer and their spouses. The value of a database in clinical care Cancer 73 2791–2802 https://doi.org/10.1002/1097-0142(19940601)73:11<2791::AID-CNCR2820731123>3.0.CO;2-9 PMID: 8194021
30. Joana T, Germano C, and Ana P, et al (2020) Sexual dysfunction and quality of life in prostate cancer 43(1) 218
31. Hathout L, Mahmoud O, and Wang Y, et al (2019) A phase 2 randomized pilot study comparing high-dose rate brachytherapy and low-dose-rate brachytherapy as monotherapy in localized prostate cancer Adv Radiat Oncol 4 631–640 https://doi.org/10.1016/j.adro.2019.04.003 PMID: 31673656 PMCID: 6817536
32. tumors of the prostate (2004) World Health Organization Classification of Tumours Pathology and Genetics of Tumors of the Urinary System and Male Genital Organs eds JN Eble, G Sauter, JI Epstein, and IA Sesterhenn (Lyon: IARC Press) pp 158–214
33. Oluwole OP, Rafindadi AH, and Shehu MS, et al (2015) A ten-year study of prostate cancer specimens at Ahmadu Bello University Teaching Hospital (A.B.U.T.H. ), Zaria, Nigeria Afr J Urol 21 5–18 https://doi.org/10.1016/j.afju.2014.09.004
34. Emiogun FE, Williams OO, and Obafunwa JO (2019) Epidemiology of prostate cancer in Nigeria: observations at Lagos State University Teaching Hospital Cancer Health Disparities 4 e1–e9
35. Ajape AA, Ibrahim KO, and Fakeye JA, et al (2010) An overview of prostate cancer diagnosis and management in Nigeria: the experience in a Nigerian tertiary hospital Ann Afr Med 9(3) 113–117 https://doi.org/10.4103/1596-3519.68353 PMID: 20710099
36. Adewumi AO, Anthonia SC, and Alabi AS, et al (2016) Pattern of prostate cancer among a Nigerian population: a study in a single tertiary care centre Niger J Med 25(1) 70–76 https://doi.org/10.4103/1115-2613.278256 PMID: 29963824
37. Ahmed RO, Sewram V, and Oyesegun AR, et al (2022) A comparison of clinicopathologic features of prostate cancer between Nigerian and South African black men Afr J Urol 28(1) 6 https://doi.org/10.1186/s12301-022-00273-y PMID: 35280496 PMCID: 8897758
38. Zelefsky MJ, Daly ME, and Valicenti RK (2013) Low-risk prostate cancer Perez and Brady’s Principles and Practice of Radiation Oncology 6th edn, eds EC Halperin, DE Wazer, CA Perez, and LW Brady (Philadelphia: Lippincott & Williams) pp 1280–1310
39. National Population Commission (NPC/Nigeria) and ICF (2019) Nigeria Demographic and Health Survey 2018 (Abuja/Rockville: NPC/ICF)
40. Erhabor O, Hussaini A, and Abdulwahab-Ahmed A, et al (2022) Some oxidative stress biomarkers among patients with prostate cancer in Sokoto, North Western Nigeria Open J Blood Dis 12 60–78 https://doi.org/10.4236/ojbd.2022.123007
41. Seibel HD (1988) Changing patterns of marriage and the family in Nigeria, 1963–1982
42. Hayes RB, Pottern LM, and Strickler H, et al (2000) Sexual behavior, STDs, and risks for prostate cancer Br J Cancer 82(3) 718–725 https://doi.org/10.1054/bjoc.1999.0986 PMID: 10682688 PMCID: 2363322
43. Oyediran K, Isiugo-Abanihe UC, and Feyisetan BJ, et al (2010) Prevalence of and factors associated with extramarital sex among Nigerian men Am J Mens Health 4(2) 124–134 https://doi.org/10.1177/1557988308330772
44. Cirakoglu A, Benli E, and Yuce A (2018) Polygamy and sexual behavior in a population under risk for prostate cancer diagnosis: an observational study from the Black Sea Region in Turkey Int Braz J Urol 44(4) 704–708 https://doi.org/10.1590/s1677-5538.ibju.2017.0525 PMID: 29570262 PMCID: 6092644
45. Albaugh JA, Sufrin N, and Lapin BR, et al (2017) Life after prostate cancer treatment: a mixed-methods study of the experiences of men with sexual dysfunction and their partners BMC Urol 17(1) 45 https://doi.org/10.1186/s12894-017-0231-5 PMID: 28619019 PMCID: 5472970
46. Soni JS, Oparah AC, and Osejie F, et al (2017) Quality of life of patients treated for prostate cancer in a Nigerian hospital J Sci Pract Pharm 4(1) 169–176
47. Rousseau L, Dupont A, and Labrie F, et al (1988) Sexuality changes in prostate cancer patients receiving antihormonal therapy combining the antiandrogen flutamide with medical (LHRH agonist) or surgical castration Arch Sex Behav 17(1) 87–98 https://doi.org/10.1007/BF01542054 PMID: 3358677
48. White ID, Wilson J, and Aslet P, et al (2015) Development of UK guidance on the management of erectile dysfunction resulting from radical radiotherapy and androgen deprivation therapy for prostate cancer Int J Clin Pract 69(1) 106–123 https://doi.org/10.1111/ijcp.12512
49. Jiann BP (2010) Effect of alcohol consumption on the risk of erectile dysfunction Urol Sci 21(4) 163–168 https://doi.org/10.1016/S1879-5226(10)60037-1
50. Lee TK, Handy AB, and Kwan W, et al (2015) Impact of prostate cancer treatment on the sexual quality of life for men who have sex with men J Sex Med 12(12) 2378–2386 https://doi.org/10.1111/jsm.13030 PMID: 26537853
51. Prostate Cancer Foundation of Australia Understanding Sexual Issues Following Prostate Cancer Treatment: Information for Men and Their Partners on Possible Sexual Side Effects of Prostate Cancer Treatment and How to Manage Them [https://www.pcfa.org.au/media/790757/pcf13464_-_07_-_understanding_sexual_issues_booklet_6.pdf]
52. Vázquez-Salas RA, Torres-Sánchez L, and López-Carrillo L, et al (2016) History of gonorrhea and prostate cancer in a population-based case-control study in Mexico Cancer Epidemiol 40 95–101 https://doi.org/10.1016/j.canep.2015.12.001
53. Strickler HD and Goedert JJ (2001) Sexual behavior and evidence for an infectious cause of prostate cancer Epidemiol Rev 23(1) 144–151 https://doi.org/10.1093/oxfordjournals.epirev.a000781 PMID: 11588840
54. Ramsey SD, Zeliadt SB, and Blough DK, et al (2013) Impact of prostate cancer on sexual relationships: a longitudinal perspective on intimate partners' experiences J Sex Med 10(12) 3135–3143 https://doi.org/10.1111/jsm.12295 PMID: 24118980 PMCID: 3855071
Appendix 1. Questionnaire.
Section A: Sociodemographic data
Study center: ____________________ Year of study ___________________
Age:______ Religion:____________ Tribe:____________ State (Origin):____________ State (Residencial)____________ Occupation: ____________
Marital Status: Single ( ) Married ( ) Separated ( ) Divorced ( ) Widow ( ) Co-habiting( ) Others
Section B: Clinical characteristics
Past history Hypertension ( ) Diabetes ( ) Seizures ( ) Asthma ( )
Others (specify) ___________________Drug history: _____________________________ Previous surgeries: _______________________________
PSA:
Histologic type:___________________
Perineural invasion: Yes ( ) No ( )Lymphovascular invasion Yes ( ) No ( )
Gleason score
Grade
Stage
Nature of specimen: Transrectal ( ) Transurethral ( ) Transperineal ( )
Prior hormone therapy and duration.
Prior EBRT (Dose, Fractionation, Dose Per Fraction Duration and Facility).
Prior chemotherapy (regimen and duration)
Brachytherapy (Dose, Fractionation, Dose/Fraction and Duration)
EBRT after brachytherapy (Dose, Fractionation, Dose/Fraction, Duration, Facility)
Section B: Sexual characteristics
Multiple wives: Yes ( ) No ( ) No of wives: ____________
Other sexual partners: Yes ( ) No ( ) No of sexual partners: ________
Age at first sexual intercourse? __________
Do you consider yourself sexually active before this diagnosis?Yes ( ) No ( )
Do you consider yourself sexually active after this diagnosis?Yes ( ) No ( )
How often do you have sex in 1 week/month: ____/Week or ____/Month
Have you ever used sexual aid like drug/alcohol?
List them: ______________________________________________
Have you ever had oral sex performed on you before? Yes( ) No( ) How often?____
Previous history of sexually transmitted disease? Yes( )No ( ) How many times?____
Do you know the diagnosis? Yes( ) No( ) List___________________
Do you know your HIV status? Yes( ) No( ) Negative or Positive _________
If positive, are you on treatment? Yes ( ) No ( )
Do you know your partners’ HIV status?Yes ( ) No ( ). Negative ( ) Positive ( )
Do you think your partner(s) are often satisfied with your performance?
Partner(s) left ( ),
Partner(s) less inclined to ask for sex ( ),
I am less inclined to ask for sex ( ),
My performance has diminished ( ),
Partner(s) complaining ( ),
Partner(s) and I have fears of passing on the disease ( )
