RESUMO
The aim of this study was to evaluate the impact of group psychotherapy and the use of a phosphodiesterase-5 inhibitor (PDE-5i) in the early rehabilitation stage of patients with prostate cancer undergoing radical prostatectomy (RP). Fifty-six patients undergoing RP for prostate cancer were randomised into four groups, and 53 completed the protocol: Group 1 - control (n = 11), Group 2 - group psychotherapy (n = 16), Group 3 - lodenafil 80 mg/one tablet per week (n = 12) and Group 4 - group psychotherapy + lodenafil 80 mg/one tablet per week (n = 14). The groups were individually evaluated for erectile function (IIEF-5) and quality of life - QoL (SF-36) weekly, with two meetings held a week apart before the RP and 12 weekly meetings after surgery. The ages ranged from 39 to 76 years, average 61.84. There were no significant medication side effects. Only Group 4 showed improvement in intimacy with a partner and satisfaction with their sex life (P = 0.045 and P = 0.013 respectively), and with no significant worsening of the IIEF-5 (P = 0.250) reported. All groups showed worsening in the final result of the role limitations caused by physical problems (P = 0.009) and role limitations caused by emotional problems (P = 0.002) of the SF-36, but Group 4 had a significantly higher score for the role limitations caused by physical problems (P = 0.009) than the other groups. In conclusion, precocious integral treatment involving group psychotherapy and PDE-5i before and after RP led to less deterioration of erectile function and other domains related to physical aspects (SF-36), with improvement in intimacy with their partner and satisfaction in their sex life, being superior to single treatments.
Assuntos
Carbonatos/uso terapêutico , Disfunção Erétil/tratamento farmacológico , Ereção Peniana/efeitos dos fármacos , Inibidores da Fosfodiesterase 5/uso terapêutico , Piperazinas/uso terapêutico , Prostatectomia/efeitos adversos , Psicoterapia , Pirimidinas/uso terapêutico , Qualidade de Vida/psicologia , Adulto , Idoso , Carbonatos/farmacologia , Terapia Combinada , Disfunção Erétil/etiologia , Disfunção Erétil/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana/psicologia , Inibidores da Fosfodiesterase 5/farmacologia , Piperazinas/farmacologia , Estudos Prospectivos , Prostatectomia/psicologia , Neoplasias da Próstata/psicologia , Neoplasias da Próstata/cirurgia , Pirimidinas/farmacologia , Resultado do TratamentoRESUMO
OBJECTIVES: To measure the impact of psychotherapy associated to the use of Tadalafil in the improvement of erectile function after radical prostatectomy. METHODS: From 132 patients surgically treated for prostate cancer, thirty sequential patients with bilateral nerve sparing, low risk controlled disease and post-surgery erectile dysfunction (ED) took Tadalafil 20mg and underwent psychotherapy sessions, both weekly for three months. Patients were interviewed to establish the quality of erection using the instrument IIEF-5 and to measure psychological features impacting erectile function, aspects related to function, dysfunction, physical and emotional discomfort were evaluated with the help of an intensity scale. RESULTS: The average age was 62.5 (46 to 77 years), 96.7% had a stable relationship, 56.6% of the patients accepted the diagnosis and 43.2% exhibited defense mechanisms (3.3% negation, 6.6% revulsion, 33.3% concern). A positive correlation was observed between erectile function and time exposed to treatment (IIEF-5 - 9.7 to 13.3, p=0.0006), with increased satisfaction with life in general (2.1 to 2.7, P=.028) and sexual life (3.1 to 3.7, P=.028), added to facilitation of expressing feelings/emotions (1.8 to 3.0, P=.0008). Satisfaction with relationship and intimacy with partner did not present significant improve (P=.12 and P=.61, respectively). CONCLUSIONS: A holistic patient care with more complete ED rehabilitation includes psychotherapy with a positive correlation between erectile function and treatment exposition. Psychotherapy allowed the identification of important spouse related factors in this scenario.
Assuntos
Disfunção Erétil/reabilitação , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostatectomia , Psicoterapia , Tadalafila/uso terapêutico , Idoso , Terapia Combinada , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Prostatectomia/efeitos adversosRESUMO
OBJECTIVE: Analyze the treatment satisfaction and impact on patients with localized prostate cancer. METHODS: One-hundred and eighty patients, with mean age of 60 years, were divided into three groups: group I--100 patients submitted to radical retropubic prostatectomy (RRP), group II--40 patients who underwent radiotherapy (RT), and group III--40 healthy men. A questionnaire was applied to the groups to assess physical and psychological changes 18 months after treatment. The investigational tool was based on two questionnaires; first: SF-36 (Short Form Health Survey), second: FACT-P (Functional Assessment Cancer Therapy). RESULTS: In group I, 70% never used pads, 5% presented with complete urinary incontinence, and 10% reported occasional stool leakage. In group II, 85% did not use pads and 5% reported two pads a day; 15% reported stool leakage or intestinal cramps. Sexual dysfunction was similar in both groups: 75% of the surgical group and 72.5% of the radiotherapy group reported erectile dysfunction. In the control group, 40% reported erectile dysfunction; 10% reported occasional stool leakage and none had changes regarding the overall treatment-related satisfaction. Seventy-eight percent of the RRP group and 77.5% of the RT group reported being happy respecting satisfaction with the accepted or chosen treatment, and affirmed that would choose it again. CONCLUSIONS: The assessment of treatment-related satisfaction determines the treatment tolerability. This study's results did not show any significant changes in this issue between both treatment modalities (p>0.05).