The Prevalence and Associated Factors of Sexual Dysfunction Among Prostate Cancer Patients on Goserelin Androgen Deprivation Therapy in Kenyatta National Hospital
Abstract
Background: The main modality of prostate cancer treatment has been Androgen
deprivation therapy (ADT) which has been demonstrated in randomized studies to
enhance overall survival when utilized for radiation for intermediate and high risk localized
disease as well as for locally advanced and node-positive disease and also for the nodepositive
disease after surgery. Though ADT may enhance survival, it can cause serious
morbidity and a decrease in life quality, the most significant of which is sexual dysfunction.
There is no local study that has been done on this important subject and the studies
elsewhere indicate that the prevalence of sexual dysfunction is high among this population.
Objective: To determine the prevalence and factors that are associated with sexual
dysfunction amongst prostate cancer patients on Goserelin Androgen deprivation therapy
in Kenyatta National Hospital.
Methods: This was a cross-sectional study done at Kenyatta National Hospital (KNH)
Urology and Oncology outpatient clinics among patients who on follow-up for cancer of
the prostate. Ninety-nine (99) were recruited through convenient sampling after giving
consent. The principal researcher and two research assistants using a questionnaire
collected the data. Each patient recruited into the study was given a special serialized
number for purposes of ordering the data collection documents. Data on the demographics
of patients, nutritional status, social habits, sexual function status using international index
of erectile function (IIEF) score, disease stage, Goserelin dosage, duration of treatment,
co-morbid and ECOG status was collected. Data analysis was done using statistical
package for social sciences (SPSS) version 25. Bivariable analysis was done using pearson
and Fischer’s exact test while binary logistic regression was used to conduct multivariable
analysis. The level of significance was investigated at 0.05.
Results: The average age of the participants was 70.4 (SD±8) years, the average body mass
index was 29.6 (SD±3) kg/m². The mean baseline and current Prostate-Specific Antigen
(PSA) was 673.6 (SD±59) ng/ml and 51.4 (SD±16) ng/ml respectively. The findings
revealed that 90% (89) of the respondents had sexual dysfunction as shown in Figure 4.1
with a 95% CI (82.2, 95.1). Bi-variable analysis showed that, Alcohol and cigarette
smoking, cOR =10.3, 95%CI: 2.0,53.04, p =0.005, tumor staging T4, cOR =16, 95%CI:
2.8, 92.4, p =0.002. very high NCCN risk classification, cOR = 9, 95%CI:1.9, 43.1, p
=0.006 and symptomatic but completely ambulatory ECOG status cOR = 7.3, 95%
CI:2.84,10.9, p=0.002 were found to be associated with sexual dysfunction. The
independent risk factors associated with sexual dysfunction were alcohol and cigarette
smoking, aOR = 5, 95% CI: 1.9, 14.6, p = 0.010 and tumor staging T4, aOR =11.1, 95%
CI:4.6,32.1, p<0.009.
Conclusion and recommendation: The findings have showed that majority of prostate
cancer patients have sexual dysfunction with tumor staging, cigarette smoking and alcohol
use key predictors. Thus, there is need educate prostate cancer patients on Goserelin ADT
about getting extra psychosexual support and physical sexual therapy, as well as availing
to patients’ options such as penile rehabilitation during hormone therapy.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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