Doctors don't always explain sexual side effects of prostate treatments

Medications that treat lower urinary tract symptoms and enlarged prostates may cause sexual dysfunction, but some urologists don’t discuss this with patients, according to a survey of doctors.

Although more than half of the physicians said they discuss ejaculatory dysfunction when prescribing the most common treatments, most don’t routinely offer alternatives, the study authors report in World Journal of Urology.

“We need to think about the entire picture as doctors. Even if patients are 100 percent satisfied with the treatment and can urinate perfectly, they may be unhappy that they can’t ejaculate anymore,” said lead study author Dr. Simone Giona of King’s College Hospital in London.

Lower urinary tract symptoms and prostatic hyperplasia - an enlarged prostate - cause difficulty with urination, urgency and leaking. Patients sometimes wait until symptoms worsen before seeking treatment, often because they know treatments could affect sexual function, Giona said.

“That’s very important for some men, even if they’re 75 or 80 years old,” Giona said in a telephone interview. “We need to talk to patients about their expectations and offer the treatments that will help them, including new alternatives.”

Giona and colleagues surveyed 245 urologists attending the 2015 World Congress of Endourology in London. They asked what prostate treatment options the urologists offered their patients, how often they discussed the different types of treatments available, how often they discussed ejaculatory dysfunction with patients and how often they discussed alternative treatments based on the risk of sexual dysfunction.

About 70 percent of survey participants said they discuss erectile dysfunction before prescribing alpha blockers, although there’s no evidence currently that these medications impair sexual function. Most urologists said they discuss treatment-related erectile dysfunction, but those with the busiest practices and higher caseloads were most likely to discuss sexual side effects.

On the other hand, most respondents said they don’t routinely discuss alternative therapies based on the risk of sexual dysfunction, and those with the highest caseloads were least likely to offer alternatives.

“We’d expect that a urologist with more experience would have a wider picture of the best treatment, but maybe they don’t discuss options other than what they prefer or know best,” Giona said. “We need to make sure patients have options and we’re not missing the rest.”

A limitation of the study is that the responses were not analyzed according to the participants’ region or country of origin, which might highlight differences in what’s available. Some countries don’t yet offer some of the treatment options, but few survey respondents marked “not applicable” while answering the questions, the study authors note.

“Patients should mention all their worries and discuss their sex life concerns,” Giona said. “Urologists should get a full picture of what will make their patients happy.”

Current guidelines recommend lifestyle modification, medication or surgery for enlarged prostates. All options can impact sexual function, but some affect libido, erection, ejaculation and semen volume more than other options. In this study, the most common treatments were medications such as alpha blockers and 5alpha-reductase inhibitors, followed by surgical options such as Transurethral Resection of the Prostate (TURP) and laser procedures such as Holmium Laser Enucleation of the Prostate (HoLEP) and GreenLight Photoselective Vaporisation of the Prostate (PVP).

“Patients didn’t previously have choices about their treatments and accepted the side effects,” said Dr. Tobias Kohler of the Mayo Clinic in Rochester, Minnesota, who wasn’t involved in the study.

“But now, we’re seeing minimally invasive treatments that offer excellent improvement and low risk of sexual side effects,” Kohler said in a telephone interview.

“Now the conversation needs to be whether patients should take a pill or treat the problem definitively and prevent the progression of bladder dysfunction,” Kohler said.

“Patients should educate themselves on the risks and benefits of prostate treatments,” he said. “Upfront procedures could offer little risk and a lot of reward.”