Who needs help most and what is the best way to help them? Developing and evaluating a preemptive educational intervention to reduce the psychological distress of androgen deprivation therapy to prostate cancer patients and their partners

When prostate cancer (PCa) can¿t be cured by treatments such as radiation or surgery, patients typically begin androgen deprivation therapy (ADT) via either chemical or surgical castration. Some 40,000 men are chemically castrated each year in North America to treat PCa. ADT causes patients¿ genitals to shrink; most lose their sex drive and become impotent. These changes are traumatic for both patients and their partners. One study suggests that approximately half of such patients experience deterioration in spousal relations. A common litany from these patients and their partners is that they were not adequately forewarned about the effects of ADT. Our first research objective is to determine whether PCa patients¿ and their partners¿ knowledge before they start ADT of the physical and psychological effects of ADT, as well as their sexual intimacy, influence: 1) the side effects the patients experience; 2) those they find most bothersome; and 3) their intimacy as a couple after the patient is on ADT. Our second research objective is to determine whether a preemptive educational intervention about the side effects of ADT¿plus strategies for overcoming them¿can reduce the distress caused by ADT on couples. Research plan: Before starting ADT, both patients and their partners will be surveyed about their knowledge of the side effects of ADT, and the nature of their relationship in terms of sexuality and intimacy. The participants will then be divided into two groups. One will participate in an educational workshop, the other will serve as a control and not receive this intervention. All patients and their partners will be re-assessed at three and six months after commencing ADT. The goal here will be to test the general hypothesis that a forthright introduction to the reality and totality of ADT¿s effects¿and strategies for overcoming them¿can help patients and their partners stave off the negative impact of androgen deprivation.