Requirement for Psychosexual Pathways
Sivarajan et al.,  examined psychosexual outcomes up to 7 years post operatively with initiation of medical therapy (n = 1896) . What was demonstrated was erectile dysfunction, persisting beyond 2 years. However, the time point at which erectile dysfunction therapy was initiated is not mentioned—this is something which should be taken into account with pathway development. This is because, the sooner the treatment is initiated, the better the erectile function outcomes. However, the study is of a high quality due to its inclusion of risk stratification prior to assessment of erectile dysfunction (Level 2b, recommendation A) . The study highlights a requirement for psychosexual pathways in order to manage patients with progressive disease, and manage them early to avoid delays in psychosexual care.