**3.2 Urination problems**

Among the study patients, 12% of them frequently passed urine during the day. This problem has a significant impact on the quality of life of the patients


**179**

(Chi2

**Table 3.**

*a*

*b*

strong (Chi<sup>2</sup>

nificant (Chi<sup>2</sup>

**Tables 4** and **5**.

nighttime urination (Chi<sup>2</sup>

*Significant correlation p < 0.05.*

p = 0.01321; R = 0.05, p > 0.05).

assessed their quality of life (Chi<sup>2</sup>

how they perceived their quality of life (Chi<sup>2</sup>

**3.3 Sexual activity of the study patients**

75–79 or 16.67% of patients over the age of 80 years) (Chi<sup>2</sup>

*Sexual and Psychoemotional Disorders in Male Patients Treated for Prostate Carcinoma*

**Emotional problems Question no.a Quality of life**

Feeling circuit 21 0.727 — Feeling worried 22 0.000 — The feeling of annoyance 23 0.353 — Feeling depressed 24 0.174 — Difficulty in remembering 25 0.020 −0.364

= 30.86, p = 0.02988; R = −0.24, p = 0.02967). Patients with no problems with

= 33.42, p = 0.01484; R = −0.11, p > 0.05) or the quality

= 54.09, p = 0.0000; R = −0.52, p = 0.0000). The

= 55.22, p = 0.00001; R = −0.23,

= 40.61, p = 0.00172;

= 33.83,

**p-value R-Spearmanb**

frequent urination during the day had a higher quality of life score compared to patients who had to urinate very frequently during the day. Similar but significantly weaker correlation was identified between the quality of life score and frequent

Over 60% of the patients indicated that having to get up at night to urinate affected their night's rest. This problem had a strong impact on how the patients

quality of life score was also affected by problems related to going out of the house due to the fact that the patients had to be close to a toilet. Problems with involuntary release of urine were indicated by nearly half of the patients, and 17% of the patients considered this problem to be considerable or significant. This group of patients usually has a lower quality of life score, even though this correlation is not

declared to have painful urination; however, no correlation was found between pain and the quality of life score (p > 0.05). Among the study patients, 32.53% of them use protection products against urinary incontinence. Using this type of protection was considered a nuisance only by 40% of the patients and affected

p = 0.03563). Generally, limitations related to everyday functioning due to urination problems were indicated by nearly 40% of men. This effect was considered significant or highly significant by 12% of the patients. However, the correlation between the limitation of everyday activities and the quality of life score is insig-

Nearly 60% of the patients indicated that they experienced a sense of loss of manhood due to the disease or its treatment. Younger patients more often declared a strong or very strong sense of loss of manhood (100% of patients under the age of 54 years, 62.5% of patients aged 55 to 59 compared to 50% of patients aged

R = 0.09, p > 0.05). A sense of loss of manhood was mostly declared by the posttreatment patients or the patients on cancer treatment (the responses "very strong" and "strong" were given by 57.89 and 75% compared to 30% of patients waiting

= 43.87, p = 0.00060; R = −0.21, p > 0.05). Nearly 50% of the patients

= 38.50, p = 0.00332; R = 0.17, p > 0.05). Detailed results are given in

of life score and the need to hurry into the toilet before passing urine (Chi2

*DOI: http://dx.doi.org/10.5772/intechopen.87208*

*Number of issues in accordance with the questionnaire QLQ-C30.*

*Emotional problems of the patients and felt the quality of life.*

### **Table 2.** *Emotional problems of the patients.*


*Sexual and Psychoemotional Disorders in Male Patients Treated for Prostate Carcinoma DOI: http://dx.doi.org/10.5772/intechopen.87208*

*b*

*Significant correlation p < 0.05.*

### **Table 3.**

*Male Reproductive Health*

chemotherapy, and hormone therapy (Chi2

both radiotherapy and surgery (42.86%).

posttreatment patients) (Chi2

the group) (Chi<sup>2</sup>

(Chi<sup>2</sup>

score (Chi<sup>2</sup>

(**Tables 2** and **3**).

**3.2 Urination problems**

**Emotional problems Question** 

*Number of issues in accordance with the questionnaire QLQ-C30.*

least irritability were experienced by patients undergoing radiotherapy or surgical treatment, the greatest irritability—by patients receiving surgical treatment,

On the other hand, no correlation was found between feeling irritable and the patients' age, health status, or quality of life score (p > 0.05 for all the cases).

that feeling depressed may depend on the patient's health status (Chi2

lated (although weakly) with the stage of the patient's treatment (Chi2

more often declared that they felt depressed during the last week.

p = 0.04122; R = 0.06, p > 0.05) and the type of treatment (Chi2

Even though no correlation was found between the age or the quality of life score and feeling depressed (p > 0.05), a statistical analysis of the study results showed

p = 0.01517; R = −0.36, p = 0.00681). Patients with a lower health status score much

p = 0.0000; R = 0.11, p > 0.05). No depression was most often indicated by patients who underwent cancer treatment (56.25% of this group), radiotherapy (45.10%), or

As with the above-described correlations, feeling depressed is also corre-

The greatest difficulties in remembering were indicated by pretreatment patients (30% of responses "to a significant degree" and "very much" in this group of patients compared to 7% of the patients on treatment and 0% of the

receiving surgical treatment, hormone therapy, and chemotherapy (100% of

correlation was found between difficulties in remembering and health status score

was found between difficulties in remembering and the patients' age (p > 0.05)

Among the study patients, 12% of them frequently passed urine during the day. This problem has a significant impact on the quality of life of the patients

**no.a**

 = 34.89, p = 0.00976; R = −0.45, p = 0.0000). The higher health status score is correlated with an absence of difficulties in remembering or only slight difficulties in remembering. Serious and very serious difficulties in remembering were indicated only by the patients with a health status score less than 5. A similar correlation exists with regard to the quality of life score. Patients with the lowest quality of life score did not indicate any considerable or significant problems in remembering. Patients who declared frequent problems in remembering had a lower quality of life

= 32.30, p = 0.02024; R = −0.26, p = 0.00071). However, no correlation

**Not at all**

Feeling circuit 21 86 (51.8) 72 (43.4) 4 (2.4) 4 (2.4) Feeling worried 22 40 (24.1) 98 (59) 22 (13.3) 6 (3.6) The feeling of annoyance 23 68 (40.9) 70 (42.2) 22 (13.3) 6 (3.6) Feeling depressed 24 70 (42.2) 72 (43.4) 18 (10.8) 6 (3.6) Difficulty in remembering 25 84 (50.6) 68 (41.0) 10 (6) 4 (2.4)

= 69.05, p = 0.0000; R = 0.06, p > 0.05).

= 33.34,

= 13.11,

= 67.37,

**Number of patients (N = 166) N (%)**

**A little Quite a** 

**bit**

**Very much**

= 19.25, p = 0.00376; R = −0.07, p > 0.05) and those

= 97.20, p = 0.0000; R = 0.08, p > 0.05). Additionally, a strong

**178**

*a*

**Table 2.**

*Emotional problems of the patients.*

*Emotional problems of the patients and felt the quality of life.*

(Chi2 = 30.86, p = 0.02988; R = −0.24, p = 0.02967). Patients with no problems with frequent urination during the day had a higher quality of life score compared to patients who had to urinate very frequently during the day. Similar but significantly weaker correlation was identified between the quality of life score and frequent nighttime urination (Chi<sup>2</sup> = 33.42, p = 0.01484; R = −0.11, p > 0.05) or the quality of life score and the need to hurry into the toilet before passing urine (Chi<sup>2</sup> = 33.83, p = 0.01321; R = 0.05, p > 0.05).

Over 60% of the patients indicated that having to get up at night to urinate affected their night's rest. This problem had a strong impact on how the patients assessed their quality of life (Chi<sup>2</sup> = 54.09, p = 0.0000; R = −0.52, p = 0.0000). The quality of life score was also affected by problems related to going out of the house due to the fact that the patients had to be close to a toilet. Problems with involuntary release of urine were indicated by nearly half of the patients, and 17% of the patients considered this problem to be considerable or significant. This group of patients usually has a lower quality of life score, even though this correlation is not strong (Chi<sup>2</sup> = 43.87, p = 0.00060; R = −0.21, p > 0.05). Nearly 50% of the patients declared to have painful urination; however, no correlation was found between pain and the quality of life score (p > 0.05). Among the study patients, 32.53% of them use protection products against urinary incontinence. Using this type of protection was considered a nuisance only by 40% of the patients and affected how they perceived their quality of life (Chi<sup>2</sup> = 55.22, p = 0.00001; R = −0.23, p = 0.03563). Generally, limitations related to everyday functioning due to urination problems were indicated by nearly 40% of men. This effect was considered significant or highly significant by 12% of the patients. However, the correlation between the limitation of everyday activities and the quality of life score is insignificant (Chi<sup>2</sup> = 38.50, p = 0.00332; R = 0.17, p > 0.05). Detailed results are given in **Tables 4** and **5**.

### **3.3 Sexual activity of the study patients**

Nearly 60% of the patients indicated that they experienced a sense of loss of manhood due to the disease or its treatment. Younger patients more often declared a strong or very strong sense of loss of manhood (100% of patients under the age of 54 years, 62.5% of patients aged 55 to 59 compared to 50% of patients aged 75–79 or 16.67% of patients over the age of 80 years) (Chi<sup>2</sup> = 40.61, p = 0.00172; R = 0.09, p > 0.05). A sense of loss of manhood was mostly declared by the posttreatment patients or the patients on cancer treatment (the responses "very strong" and "strong" were given by 57.89 and 75% compared to 30% of patients waiting


*b Question applies only to patients wearing protection against urinary incontinence (N = 54).*

### **Table 4.**

*Problems with urinating in the group of patients studied.*


*a Number of issues in accordance with the questionnaire QLQ-C30.*

*b Demonstrated statistically significant correlations only; p < 0.05.*

*c Question applies only to patients wearing protection against urinary incontinence (N = 54).*

### **Table 5.**

*Problems with urination and the evaluation of the quality of life for patients.*

for treatment) (Chi<sup>2</sup> = 14.74, p = 0.02230; R = 0.15, p > 0.05). The type of treatment had no impact on a sense of loss of manhood (p > 0.05). Nearly half of the patients had no interest in sexual life during the last 4 weeks (45.8%). No interest in having sex was mostly indicated by elderly patients over 70 years of age. None of the patients under 60 years of age selected the response "none" (Chi2 = 41.22,

**181**

(Chi2

*Sexual and Psychoemotional Disorders in Male Patients Treated for Prostate Carcinoma*

and hormone therapy—greatest interest in sexual life (Chi<sup>2</sup>

30% of the patients declared lack of sexual activities (Chi2

= 46.43, p = 0.00026; R = 0.04, p > 0.05).

affected satisfaction with sexual life (Chi<sup>2</sup>

with sexual life (p > 0.05).

going radiotherapy (43.33%) (Chi<sup>2</sup>

difficulties with ejaculation (Chi<sup>2</sup>

cancer treatment (Chi2

are shown in **Tables 6** and **7**.

treatment (Chi<sup>2</sup>

therapy.

of the patients) (Chi2

p = 0.00142; R = 0.08, p > 0.05). As regards the stage of oncological treatment, 43.75% of the posttreatment patients and 52.63% of the patients on treatment had no interest in sex. Among the patients waiting for treatment, it was 10%

 = 26.89, p = 0.00015; R = 0.18, p > 0.05). Patients undergoing radiotherapy or radiotherapy and hormone therapy showed least interest in sexual life, while patients undergoing surgical treatment or surgical treatment, chemotherapy,

R = 0.09, p > 0.05). Nearly 60% of the patients were not sexually active during the last 4 months, and there is no correlation between the level of sexual activity and the patient's age (p > 0.05). The posttreatment patients and those on treatment were least sexually active (the response "none" was indicated by 64.91% and 50% of the patients in these groups, respectively). Among the patients waiting for treatment,

R = 0.12, p > 0.05). Based on an analysis of the type of treatment, it can be shown that patients who underwent surgical treatment or chemotherapy and hormone therapy were characterized by greatest sexual activity (100% in both cases). In the other treatment categories, the percentage of sexually active men was about 40%

Among the patients who were sexually active during the last 4 months, 37% of them were satisfied or very satisfied with their sexual life. High or very high satisfaction with sexual life was indicated by 50% of the patients prior to cancer treatment, 12.5% of the posttreatment patients, and 7% of the patients on treat-

Patients undergoing surgical procedures, hormone therapy, and chemotherapy were very satisfied with their sexual life, while patients undergoing only surgical procedures or surgical procedures combined with radiotherapy declared low or no satisfaction with their sexual life. The patient's age has no effect on his satisfaction

Difficulties with achieving or maintaining erection were declared by 73.3% of the sexually active patients, regardless of their age (p > 0.05). Significant or considerable difficulties were most often indicated by patients on cancer treatment (30%

Difficulties with ejaculation were declared by 66.7% of the sexually active patients, even though these problems are not related to the patients' age (p > 0.05). Problems with ejaculation were least frequent among patients prior to cancer treatment (50%), while all the posttreatment patients reported having such difficulties

A feeling of embarrassment during intimate contact was indicated only by 56.7% of the sexually active patients. The above variable was not age-dependent (p > 0.05). However, a feeling of embarrassment was correlated with the stage of

sexual contact was not experienced by pretreatment patients, patients receiving surgical treatment, hormone therapy or radiotherapy in combination with hormone

It should be pointed out that none of the discussed aspects of sexual activity, in relation to all the patients or only those sexually active during the last 4 months, had no impact on the quality of life score (p > 0.05 for all cases). The above results

 = 34.44, p = 0.00003 R = 0.27, p = 0.01530). Patients who received surgical treatment, hormone therapy, or both radiotherapy and hormone therapy had no

= 23.89, p = 0.00239; R = 0.33, p = 0.00228). The type of treatment also

= 16.71, p = 0.03328; R = 0.29, p = 0.00839) or patients under-

= 61.98, p = 0.00003; R = −0.01, p > 0.05).

= 45.58, p = 0.00496; R = 0.04, p > 0.05).

= 16.85, p = 0.03164; R = 0.30, p = 0.00526) and the type of

= 40.05, p = 0.02111; R = 0.00, p > 0.05). Embarrassment during

= 55.75, p = 0.00001;

= 20.32, p = 0.00234;

= 76.52, p = 0.0000; R = 0.05, p > 0.05).

*DOI: http://dx.doi.org/10.5772/intechopen.87208*

(Chi2

(Chi2

ment (Chi2

### *Sexual and Psychoemotional Disorders in Male Patients Treated for Prostate Carcinoma DOI: http://dx.doi.org/10.5772/intechopen.87208*

p = 0.00142; R = 0.08, p > 0.05). As regards the stage of oncological treatment, 43.75% of the posttreatment patients and 52.63% of the patients on treatment had no interest in sex. Among the patients waiting for treatment, it was 10% (Chi2 = 26.89, p = 0.00015; R = 0.18, p > 0.05). Patients undergoing radiotherapy or radiotherapy and hormone therapy showed least interest in sexual life, while patients undergoing surgical treatment or surgical treatment, chemotherapy, and hormone therapy—greatest interest in sexual life (Chi<sup>2</sup> = 55.75, p = 0.00001; R = 0.09, p > 0.05). Nearly 60% of the patients were not sexually active during the last 4 months, and there is no correlation between the level of sexual activity and the patient's age (p > 0.05). The posttreatment patients and those on treatment were least sexually active (the response "none" was indicated by 64.91% and 50% of the patients in these groups, respectively). Among the patients waiting for treatment, 30% of the patients declared lack of sexual activities (Chi2 = 20.32, p = 0.00234; R = 0.12, p > 0.05). Based on an analysis of the type of treatment, it can be shown that patients who underwent surgical treatment or chemotherapy and hormone therapy were characterized by greatest sexual activity (100% in both cases). In the other treatment categories, the percentage of sexually active men was about 40% (Chi2 = 46.43, p = 0.00026; R = 0.04, p > 0.05).

Among the patients who were sexually active during the last 4 months, 37% of them were satisfied or very satisfied with their sexual life. High or very high satisfaction with sexual life was indicated by 50% of the patients prior to cancer treatment, 12.5% of the posttreatment patients, and 7% of the patients on treatment (Chi2 = 23.89, p = 0.00239; R = 0.33, p = 0.00228). The type of treatment also affected satisfaction with sexual life (Chi<sup>2</sup> = 76.52, p = 0.0000; R = 0.05, p > 0.05). Patients undergoing surgical procedures, hormone therapy, and chemotherapy were very satisfied with their sexual life, while patients undergoing only surgical procedures or surgical procedures combined with radiotherapy declared low or no satisfaction with their sexual life. The patient's age has no effect on his satisfaction with sexual life (p > 0.05).

Difficulties with achieving or maintaining erection were declared by 73.3% of the sexually active patients, regardless of their age (p > 0.05). Significant or considerable difficulties were most often indicated by patients on cancer treatment (30% of the patients) (Chi2 = 16.71, p = 0.03328; R = 0.29, p = 0.00839) or patients undergoing radiotherapy (43.33%) (Chi<sup>2</sup> = 61.98, p = 0.00003; R = −0.01, p > 0.05).

Difficulties with ejaculation were declared by 66.7% of the sexually active patients, even though these problems are not related to the patients' age (p > 0.05). Problems with ejaculation were least frequent among patients prior to cancer treatment (50%), while all the posttreatment patients reported having such difficulties (Chi2 = 34.44, p = 0.00003 R = 0.27, p = 0.01530). Patients who received surgical treatment, hormone therapy, or both radiotherapy and hormone therapy had no difficulties with ejaculation (Chi<sup>2</sup> = 45.58, p = 0.00496; R = 0.04, p > 0.05).

A feeling of embarrassment during intimate contact was indicated only by 56.7% of the sexually active patients. The above variable was not age-dependent (p > 0.05). However, a feeling of embarrassment was correlated with the stage of cancer treatment (Chi2 = 16.85, p = 0.03164; R = 0.30, p = 0.00526) and the type of treatment (Chi<sup>2</sup> = 40.05, p = 0.02111; R = 0.00, p > 0.05). Embarrassment during sexual contact was not experienced by pretreatment patients, patients receiving surgical treatment, hormone therapy or radiotherapy in combination with hormone therapy.

It should be pointed out that none of the discussed aspects of sexual activity, in relation to all the patients or only those sexually active during the last 4 months, had no impact on the quality of life score (p > 0.05 for all cases). The above results are shown in **Tables 6** and **7**.

*Male Reproductive Health*

**Problems with urination Question** 

The need to accelerate the toilet before

The impact of waking up at night to night

Problems with leaving home because of the

Problems with wearing protection against

Limitation of daily activities by problems

*Number of issues in accordance with the questionnaire QLQ-C30.*

Problems with leaving home because of the frequent need to

*Number of issues in accordance with the questionnaire QLQ-C30.*

*Demonstrated statistically significant correlations only; p < 0.05.*

*Problems with urinating in the group of patients studied.*

*Question applies only to patients wearing protection against urinary incontinence (N = 54).*

frequent need to use the toilet

urinating

incontinence

with urination

use the toilet

*a*

*b*

**Table 4.**

stay

**no.a**

Frequent urination during the day 31 14 (8.4) 76 (45.8) 56 (33.7) 20 (12.1) Frequent urination during the night 32 22 (13.3) 82 (49.4) 44 (26.5) 18 (10.8)

Involuntary leakage of urine 36 86 (51.81) 52 (31.33) 18 (10.8) 10 (6) Pain when urinating 37 84 (50.6) 70 (42.2) 6 (3.6) 6 (3.6)

**Problems with urination Question no.a Quality of life**

Frequent urination during the day 31 0.029 0.239 Frequent urination during the night 32 0.014 — The need to accelerate the toilet before urinating 33 0.013 — The impact of waking up at night to night stay 34 0.000 −0.518

Involuntary leakage of urine 36 0.000 — Pain when urinating 37 0.060 — Problems with wearing protection against incontinence 38c 0.000 −0.231 Limitation of daily activities by problems with urination 39 0.003 —

**Number of patients (N = 166) N (%)**

**bit**

**Very much**

**Not at all A little Quite a** 

33 48 (28.9) 64 (38.6) 28 (16.9) 26 (15.7)

34 56 (33.7) 64 (38.6) 36 (21.7) 10 (6)

35 80 (48.2) 60 (36.1) 14 (8.43) 12 (7.2)

38b 32 (59.3) 16 (29.6) 6 (3.6) 0 (0)

39 102 (61.5) 44 (26.5) 14 (8.4) 6 (3.6)

**180**

*a*

*b*

*c*

**Table 5.**

for treatment) (Chi<sup>2</sup>

= 14.74, p = 0.02230; R = 0.15, p > 0.05). The type of treat-

= 41.22,

**p-value R-Spearmanb**

35 0.002 −0.314

ment had no impact on a sense of loss of manhood (p > 0.05). Nearly half of the patients had no interest in sexual life during the last 4 weeks (45.8%). No interest in having sex was mostly indicated by elderly patients over 70 years of age. None

of the patients under 60 years of age selected the response "none" (Chi2

*Question applies only to patients wearing protection against urinary incontinence (N = 54).*

*Problems with urination and the evaluation of the quality of life for patients.*


*a Number of issues in accordance with the questionnaire QLQ-C30.*

*b Question applies only to patients who are sexually active within the last 4 weeks (N = 60).*

### **Table 6.**

*Sexual activity patients.*


*a Number of issues in accordance with the questionnaire QLQ-C30.*

*b Demonstrated statistically significant correlations only; p < 0.05.*

*c Question applies only to patients who are sexually active within the last 4 weeks (N = 60).*

**Table 7.**

*Sexual activity and quality of life of the patients.*
