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consensus statement

       Canadian consensus algorithm for erectile rehabilitation following

       prostate cancer treatment

       Dean S. Elterman, MD ; Anika R. Petrella, MD ; Lauren M. Walker, MD ;Brandon Van Asseldonk, MD ;
       Leah Jamnicky, MD ; Gerald B. Brock, MD ; Stacy Elliott, MD ; Antonio Finelli, MD ; Jerzy B. Gajewski, MD ;
       Keith A. Jarvi, MD ; John Robinson, MD ; Janet Ellis, MD ; Shaun Shepherd, MD ; Hossein Saadat, MD ;
       Andrew Matthew, MD   1
       1 Division of Urology, University Health Network, Toronto, ON, Canada;  Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada;  Department of Surgery, St. Joseph’s Hospital,
       London, ON, Canada;  Department of Urology, Dalhousie University, Halifax, NS, Canada;  Murray Koffler Urologic Wellness Center, Mount Sinai Hospital, Toronto, ON, Canada;  Clinical Psychology
       Department, University of Calgary, Calgary, AB, Canada;  Department of Psychology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
       Cite as: Can Urol Assoc J 2019;13(8):239-45.  Introduction
                                                             Prostate cancer (PCa) is the second most frequent cancer
       Published online December 3, 2018                     found in men, accounting for 21% of the estimated new
                                                             annual cancer cases.  A number of treatment options are
       Abstract                                              available to patients with PCa, including active surveillance
                                                             (AS), radiotherapy (RT), and radical prostatectomy (RP).
       Introduction: The present descriptive analysis carried out by a   Treatment options are chosen based on a number of fac-
       pan-Canadian panel of expert healthcare practitioners (HCPs)   tors, such as clinical stage, patient’s age, and the presence
       summarizes best practices for erectile rehabilitation following   of comorbid diseases in the patient. 3,4
       prostate cancer (PCa) treatment. This algorithm was designed to   PCa treatments, regardless of modality, increase the likeli-
       support an online sexual health and rehabilitation e-clinic (SHARe-  hood of erectile dysfunction (ED).  Rates for ED lasting two
       Clinic), which provides biomedical guidance and supportive care                                  5,6
       to Canadian men recovering from PCa treatment. The implications   years or more following RP range from 66‒75%.  Similar
       of the algorithm may be used to inform clinical practice in com-  results are reported in men following RT at three years
       munity settings.                                      (37‒81%).  ED rates have been found to be 10- to 15-fold
       Methods: Men’s sexual health experts convened for the TrueNTH   higher in men with PCa than their similarly aged peers.  ED
       Sexual Health and Rehabilitation Initiative Consensus Meeting to   is a significant threat to the quality of life of men diagnosed
       address concerns regarding erectile dysfunction (ED) therapy and   with PCa, as 60% of affected men experience severe distress
       management following treatment for PCa. The meeting brought   from ED. 9-11  The loss of sexual activity and resultant chal-
       together experts from across Canada for a discussion of current prac-  lenge to masculinity have been shown to negatively affect
       tices, latest evidence-based literature review, and patient interviews.  quality of life. 12
       Results: An algorithm for ED treatment following PCa treatment is   Currently, there remains a gap in the systematic and com-
       presented that accounts for treatment received (surgery or radia-  prehensive care of sexual dysfunction after PCa treatment.
       tion), degree of nerve-sparing, and level of pro-erectile treatment
       invasiveness based on patient and partner values. This algorithm   This presents a significant barrier to continuity of care for
       provides an approach from both a biomedical and psychosocial   PCa survivors across Canada. The TrueNTH SHARe Clinic
       focus that is tailored to the patient/partner presentation. Regular   was developed to provide sexual health support to men
       sexual activity is recommended, and the importance of partner   across Canada. The present manuscript incorporates research
       involvement in the treatment decision-making process is high-  evidence, patient perspectives, and clinical expertise from
       lighted, including the management of partner sexual concerns.   experts in the field. To address the lack of consistency in
       Conclusions: The algorithm proposed by expert consensus consid-  care of sexual dysfunction after PCa treatment, a meeting
       ers important factors like the type of PCa treatment, the timeline   was held. The TrueNTH Sexual Health and Rehabilitation
       of erectile recovery, and patient values, with the goal of becom-  Initiative Consensus Meeting was held with the purpose of
       ing a nationwide standard for erectile rehabilitation following   developing an ED therapy algorithm following PCa treat-
       PCa treatment.
                                                             ment. The algorithm would be disseminated and used in the
                                                             TrueNTH SHARe Clinic. The present manuscript describes
                                                             the development of an ED therapy algorithm that uniquely

                                                 CUAJ • August 2019 • Volume 13, Issue 8                      239
                                                  © 2019 Canadian Urological Association
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