Showing papers by "Craig F. Donatucci published in 2013"

Sexual bother and function after radical prostatectomy: predictors of sexual bother recovery in men despite persistent post‐operative sexual dysfunction

Abstract: Changes in sexual bother (SB) following radical prostatectomy (RP) negatively affect health-related quality of life (HRQoL) of prostate cancer survivors. However, post-operative SB tends to be neglected whereas sexual function (SF) is thoroughly assessed in clinical practice and few studies have focused on and evaluated patients' SB. We retrospectively reviewed 2 345 consecutive patients who underwent RP between 2001 and 2009 at a single institution. SF and SB were assessed using Expanded Prostate Cancer Index Composite (EPIC) questionnaires. We stratified our cohort by SB recovery and post-operative SF status, including a subset of men who recovered SB despite persistent post-RP sexual dysfunction. Multivariable logistic regression analyses were conducted to identify factors for men who have SB recovery. Of 319 eligible patients, 133 (41.7%) recovered their SB at a mean of 20 months after RP. Among the 133 men who demonstrated SB recovery, 109 had post-operative sexual dysfunction. Patients with SB recovery despite post-RP sexual dysfunction were more likely to be old (p = 0.004), to have higher clinical T stage (p < 0.001), to have more non-nerve-sparing RP (p < 0.001), to have lower pre-operative EPIC-SF/SB scores (p < 0.001), to have more extracapsular extension (p = 0.031) and to be PDE5i non-users after surgery (p < 0.001). In multivariable analysis, predictors for this subset were lower comorbidity (OR 0.62, p = 0.043), higher clinical cancer stage (OR 2.35, p = 0.026), worse pre-operative SF (OR 0.98, p = 0.010), SB (OR 0.98, p < 0.010) and no PDE5i use (OR 0.37, p = 0.002); age was not related (OR 0.99, p = 0.555). As SB can influence patients' overall HRQoL, expectations of SB recovery should be provided to patients in the same way that SF recovery is presented. This study may help clinicians to discuss SB with patients and assess their potential for SB recovery following RP.

The Institute of Medicine White Paper on Testosterone: Current Perspective

Abstract: Good health and normal sexual function in males require functioning testicles, a fact known since antiquity. It is only more recently that the source of that effect was attributed to testosterone. Several centuries ago, Arnould Berthold castrated a rooster as part of an experiment, which resulted in loss of the physical signs of masculinization. Berthold realized that something manufactured by the testes was responsible for maintenance of virilization; returning the testicles to the intra-abdominal cavity of the rooster led to a restoration of its phenotype. Because Berthold had severed the neurovascular connection of the testis to the body, he correctly surmised that the testicles produced a secretion that must act through the circulatory system. It was Charles Brown-Sequard who confirmed the testes as the source of the secretion of this “hormone.” After he extracted fluid from the testis of dogs and injected himself with this fluid, he experienced improvements in strength, appetite, and mentation and published the results. The exact chemical messenger remained unidentified until 1935, when David et al. published the structure of the steroidal chemical and named the compound “testosterone.” Shortly thereafter, Butenandt and Ruzicka published near simultaneous manuscripts describing the methods for testosterone synthesis, which resulted in them subsequently sharing the Nobel Prize.