Acceptance and Commitment Therapy for Erectile Dysfunction Following Radical Pros

描述(由申请人提供)：医学研究所最近的报告强调了解决癌症幸存者性功能障碍的明显需要。前列腺癌是美国男性最常见的癌症；90%的前列腺癌是在早期诊断出来的，相对5年和10年生存率超过90%。前列腺癌治疗的一个主要副作用是勃起功能障碍(ED)，多达85%的男性报告在早期治疗4年后出现勃起问题。勃起功能障碍可能会对生活质量产生负面影响。患有勃起功能障碍的男性报告说，他们明显感到沮丧，抑郁症状增加，总体生活幸福感降低。勃起功能障碍也可能对男性的亲密关系产生有害影响，经常会导致关系紧张、亲密程度降低，以及女性伴侣的性功能障碍。前列腺癌根治术是早期前列腺癌的金标准治疗方法之一，医学界对前列腺癌根治术后勃起功能障碍的认识已取得重要进展。目前对RP后勃起功能障碍的最佳治疗方法是“勃起康复”。尽管医学上取得了这些进步，但挫折感、羞耻感和失望往往会导致男性避免为ED寻求和持续治疗。这种延迟和难以持续的治疗可能对接受射频治疗的男性尤其有害，因为对于勃起康复来说，在射频治疗后立即开始治疗并在射频治疗后持续2年是非常必要的。我们提出了一种创新的心理干预措施，将与勃起康复计划相结合。这项治疗将包括7次治疗(4次面对面治疗，3次电话治疗)，帮助男性接受勃起功能障碍治疗的需要，确定并克服这种治疗的障碍，然后致力于勃起康复计划。这一新的干预将利用认知-行为治疗接受和承诺疗法(ACT)的治疗概念，并将这些概念应用于RP后的ED(即干预名称，ACT-ED)。这一干预措施的创新之处在于1)转向主动关注勃起康复，增加了勃起恢复的机会，避免了与慢性ED相关的心理社会问题；2)将ACT概念应用于性医学的新方法。我们的研究小组位置独特，有资格进行这种类型的干预。这项建议与PA-09-130 R21机制相关，因为它将评估将这一创新干预应用于新环境的可行性和初步效果，对数十万前列腺癌幸存者具有很高的意义。该研究的主要目的是调查纳入勃起康复计划(即ACT-ED)的心理治疗的可行性、耐受性和可接受性。第二个目的是调查ACT-ED对阴茎注射依从性、勃起功能障碍治疗满意度、性功能、性自尊、勃起功能障碍、抑郁症状、接受度和自我意识的影响。 公共卫生相关性：尽管前列腺癌治疗挽救了生命，但对幸存者来说，在性健康方面可能会有很高的成本。前列腺癌是美国男性最常见的癌症类型；超过90%的男性在早期被诊断出来，5年和10年存活率超过90%。由于85%接受早期癌症治疗的男性报告勃起困难，前列腺癌早期治疗后的性功能影响数十万前列腺癌幸存者。ACT-ED旨在通过提供简短的干预来促进对ED的接受，并承诺在根治性前列腺切除术后进行勃起康复计划，以改善性功能，从而解决这一重大的生存问题。

DESCRIPTION (provided by applicant): The Institute of Medicine's recent report highlights the distinct need to address sexual dysfunction in cancer survivors. Prostate cancer is the most common cancer in men in the US; 90 percent of all prostate cancers are diagnosed in the early stage, and the relative 5 and 10 year survival rates are over 90 percent. A primary side-effect of prostate cancer treatment is erectile dysfunction (ED), with as many as 85 percent of men reporting problems with erections more than 4 years after early stage treatment. ED can have negative quality of life implications. Men who have ED report significant frustration, increased depressive symptoms, and reduced general happiness with life. ED can also have deleterious effects on men's intimate relationships, often times causing relationship stress, a reduction in intimacy, and sexual dysfunctions in female partners. Radical prostatectomy (RP) is one of the gold standard treatments for early stage prostate cancer, and the medical field has made important advances in understanding ED after RP. The current best practices treatment for ED after RP is the concept of "erectile rehabilitation." Despite these medical advances, frustration, shame, and disappointment often lead men to avoid seeking and sustaining treatment for ED. This delay in pursuing and difficulty sustaining treatment can be especially damaging in men following RP since it is imperative for erectile rehabilitation that treatment start immediately after RP and continue for 2 years post RP. We propose an innovative psychological intervention that will be integrated with an erectile rehabilitation program. This treatment will consist of 7 sessions (4 sessions in person, 3 over the phone) that will help men accept the need for ED treatment, identify and overcome the barriers to this treatment, and then commit to an erectile rehabilitation program. This novel intervention will utilize therapeutic concepts from the cognitive-behavioral treatment Acceptance and Commitment Therapy (ACT), and apply these concepts to ED after RP (i.e., intervention name, ACT-ED). The innovativeness of this intervention lies in 1) the shift to a proactive focus on erectile rehabilitation, increasing the chance of erectile recovery and avoiding the psychosocial issues related to chronic ED, and 2) the novel approach of applying ACT concepts to sexual medicine. Our research group is uniquely situated and qualified to run this type of intervention. This proposal is relevant to the PA-09-130 R21 mechanism as it will assess the feasibility and initial efficacy of applying this innovative intervention to a novel setting, with high significance for hundreds of thousands of prostate cancer survivors. The primary aim of the study is to investigate the feasibility, tolerability, and acceptability of a psychotherapy treatment integrated into an erectile rehabilitation program (i.e., ACT-ED). The secondary aim is to investigate the impact of ACT-ED on penile injection compliance, ED treatment satisfaction, sexual functioning, sexual self-esteem, ED bother, depression symptoms, acceptance and self-awareness. PUBLIC HEALTH RELEVANCE: Although life saving, prostate cancer treatment can have a high cost to survivors in regard to their sexual health. Prostate cancer is the most common type of cancer in men in the US; over 90 percent of men are diagnosed in the early stage, and the 5 and 10 year survivor rates are over 90 percent. Since 85 percent of men treated for early stage cancer report difficulties with erections, sexual functioning after early stage treatment for prostate cancer impacts hundreds of thousands of prostate cancer survivors. ACT-ED is designed to address this significant survivorship issues by providing a brief intervention to promote acceptance of ED and a commitment to an erectile rehabilitation program after radical prostatectomy to improve sexual functioning.