Introduction

Prostate cancer is a common type of cancer in men. While advancements in treatments have led to much higher survival rates (specifically 5-year survival rates of 97% and 93% in the U.S. and Canada, respectively), prostate cancer and its treatments can have a big impact on a man’s sexual functioning.

Radical prostatectomy and radiation therapy for prostate cancer can cause erectile dysfunction (ED). Tools such as vacuum erection devices and intracavernosal injections can help, but men and their sexual partners may still struggle with the emotional fallout of these changes in sexual function.

Group mindfulness and group cognitive behavioral therapy (CBT) are two psychological treatments that may help couples cope with sexual dysfunction. Mindfulness is a practice aimed at developing a non-judgmental response to present events and feelings. While practicing mindfulness, a person is encouraged to accept their thoughts and external stimuli without judgement and focus on their feelings and bodily sensations without trying to change them.

On the other hand, CBT is a treatment that is focused on recognizing negative thought patterns and challenging them to improve a person’s mood or avoidance behavior. Both mindfulness and CBT can be conducted in group settings, and both have shown positive results for patients experiencing mood disorders, depression, anxiety, and sexual dysfunction.

Methods

The authors of a recent study sought to determine how effective group mindfulness and group CBT are at improving the sexual, relational, and psychological well-being of prostate cancer patients with sexual dysfunction and their sexual partners.

To do this, they randomized 68 prostate cancer survivors and their partners into three treatment groups: 4 weeks of couples’ mindfulness therapy, 4 weeks of couples’ CBT, or no treatment (the control group).

Then, they assessed the couples’ sexual distress, relationship satisfaction, quality of life, depression and anxiety symptoms, and trait mindfulness at baseline, 6 weeks after treatment, and 6 months after treatment. Additionally, the researchers measured the prostate cancer survivors’ sexual satisfaction at these times. The following scales/measures were used in this study:

• The Female Sexual Distress Scale-Revised for sexual distress (this measure is valid for both men and women due to its gender-neutral wording).
• The International Index of Erectile Function (IIEF) and the IIEF for Men Who Have Sex With Men (IIEF-MSM) for the survivors’ sexual satisfaction.
• The adapted Dyadic Adjustment Scale (DAS-7) for relationship satisfaction.
• The World Health Organization Quality of Life–BREF (WHOQOL-BREF) scale for quality of life.
• The Hospital Anxiety and Depression Scale (HADS) for psychological symptoms.
• The Five Facet Mindfulness Questionnaire–Short Form for trait mindfulness.

Results

Ultimately, 55 couples completed the 4 weeks of treatment, with 28 couples in CBT, 27 in mindfulness therapy, and 9 in the control group. The investigators found that sexual distress and sexual satisfaction were significantly improved after mindfulness and CBT when compared with the control group. However, only sexual distress continued to be significantly improved at the 6-month mark.

Relationship satisfaction decreased slightly over time for all participants, but the change was not significant. The prostate cancer survivors saw greater increases in quality-of-life measures than their partners 6 months after treatments. Couples in the mindfulness group saw an overall improvement in quality of life 6 weeks after treatment.

Lastly, there were no significant changes in psychological symptoms or trait mindfulness for the participants, but the mindfulness intervention appeared to lead to greater couple intimacy after the study ended.

Discussion & Conclusion

This study showed that group mindfulness and group CBT may be beneficial for prostate cancer survivors who are dealing with sexual dysfunction and their partners.

The authors concluded, “Mindfulness and CBT were effective at improving select sexual outcomes in [prostate cancer] PCa survivors and their partners. Interventions led to long-term improvements in sexual distress for couples after PCa despite no changes to sexual function, and PCA survivors’ overall sexual satisfaction improved in the short term. As well, therapies improved secondary outcomes of quality of life, especially for PCa survivors. These therapies could improve sexual outcomes after PCa treatments, thus addressing the largest reported unmet need among this population.”

References:

• Kemerer, B.M., Zdaniuk, B., Higano, C.S., Bossio, J.A., Camara Bicalho Santos, R., Flannigan, R., & Brotto, L.A. (2023). A randomized comparison of group mindfulness and group cognitive behavioral therapy vs control for couples after prostate cancer with sexual dysfunction. The Journal of Sexual Medicine, 20(3), 346-366. https://doi.org/10.1093/jsxmed/qdac038