Introduction: Up to 85% of men experience sexual dysfunction following prostate cancer treatment. This loss of sexual function can profoundly affect psychological well-being and intimate relationships. While effective treatments exist, distress about the loss of sexuality can lead men to avoid using these therapies. This study tested a novel psychological intervention based on Acceptance and Commitment Therapy (ACT), using a biopsychosocial approach to improve engagement with erectile dysfunction (ED) treatment.
Sample/Procedures: Men initiating penile injection therapy (PIT) for ED were randomized to receive either ACT or Enhanced Monitoring and Education (EME). Both groups received PIT, three intervention sessions (30–45 minutes), and ten booster sessions (10 minutes). Assessments were conducted at baseline, 6 months, and 12 months. Primary outcomes were injections per week and compliance (≥2 injections/week). Secondary outcomes included psychosexual measures.
Results: 198 men were randomized (ACT n=99, EME n=99); mean age was 60±7 years. Compared to EME, the ACT group reported significantly more injections per week (6m: median 1.8 vs. 1.2; 12m: 2.0 vs. 1.4; p=0.01) and higher compliance (6m: 65% vs. 35%, RR=1.86; 12m: 79% vs. 41%, RR=1.93; p=0.01). ACT participants also showed fewer depressive symptoms (p<0.05), greater satisfaction with ED treatment (d=0.6), and improved sexual self-esteem (d=0.2).
Conclusion and Clinical Implications: ACT significantly improved treatment adherence and psychosexual outcomes among men using PIT. These findings support the value of a biopsychosocial model involving a multidisciplinary team to address sexual health and psychological recovery following prostate cancer treatment.
Source of funding: US National Institutes of Health: R01 CA 190636