A Longitudinal Study of Predictors of Sexual Dysfunction in Men on Active Surveillance for Prostate Cancer

Abstract

AimThe aim of this study was to examine the relationship between sexual dysfunction, repeat biopsies and other demographic and clinical factors in men on active surveillance (AS).MethodsPatient-reported outcomes (PROs) measures were administered at enrollment and every 6 months to assess quality of life (QOL), psychosocial and urological health outcomes. Using mixed-effects models, we examined the impact of repeat biopsies, total number of cores taken, anxiety, age, and comorbidity on sexual function over the first 24 months of enrolling in AS.Main Outcome MeasuresPROs included the Expanded Prostate Cancer Index Composite-26 (EPIC-26) Sexual Function (SF) subscale, the American Urological Association-Symptom Index (AUA-SI), and the Memorial Anxiety Scale for Prostate Cancer (MAX-PC).ResultsAt enrollment (n = 195), mean age was 66.5 ± 6.8 with a mean EPIC-26 SF score of 61.4 ± 30.4. EPIC-26 SF scores steadily decreased to 53.9 ± 30.7 at 24 months (P < 0.01). MAX-PC scores also progressively decreased over time (P = 0.03). Factors associated with lower EPIC-26 scores over time included age, unemployed status, diabetes, coronary artery disease, and hypertension (all P < 0.05). Higher prostate-specific antigen (PSA) was associated with a more rapid decline in EPIC-26 SF over time (P = 0.03). In multivariable analysis, age, diabetes, and PSA × time interaction remained significant predictors of diminished sexual function. Anxiety, number of biopsies, and total cores taken did not predict sexual dysfunction or change over time in our cohort.ConclusionsMen on AS experienced a gradual decline in sexual function during the first 24 months of enrollment. Older age, PSA × time, and diabetes were all independent predictors of diminished sexual function over time. Anxiety, AUA-SI, the number of cores and the number of biopsies were not predictors of reduced sexual function in men in AS.

Investigating the psychological impact of active surveillance or active treatment in newly diagnosed favorable‐risk prostate cancer patients: A 9‐month longitudinal study

“…The increase in AS patients' generalized anxiety symptoms over time contradicts previous research that reported declining anxiety in this group . Much of international AS research has been conducted on men being managed in centers with a strong focus on AS who have been refining and perfecting the diagnosis experience for almost two decades, and therefore AS is more widely accepted by clinicians and patients .…”

New Onset of Erectile Dysfunction in a Cohort of Patients Enrolled in Active Surveillance for Low Risk Prostate Cancer: A Preliminary Study to Evaluate Incidence and Prognostic Factors

“…Neither erectile function nor sexual activity status was associated with number of PBs [10]. In a longitudinal work of Sahane M. Pearce et al [11] were evaluated 195 patients during the first 24 months of active surveillance, highlighting a decline in sexual function. Men experienced decreased sexual function and a decline in PCa anxiety over the first 24 months of enrollment on an AS protocol.…”

“…Anxiety, other comorbid conditions, the number of cores, and the number of biopsies were not associated with declining sexual function in their study. Sexual function in men undergoing AS is multifactorial and is influenced by many factors including age, aging over time and comorbid conditions rather than increased biopsy exposure [11].…”

Erectile Dysfunction: The Problem Hiding Behind Prostate Cancer

“…However, these factors have already been mentioned as risk factors by Pearle et al as well as in the EAU Guidelines on Erectile Dysfunction [6,7].…”

“…According to PRIAS study, this anxiety decreases after 18 months of AS [5]. Considering the cooccurrence of ED with anxiety, ED is rather an early problem of AS and this topic is already covered by Pearce et al but using different parameters for erectile function assessment [6]. Quaresima et al preferred the IIEF-5 questionnaire, which provided high sensitivity and specificity and is recommended by the European Association of Urology (EAU) Male Sexual Dysfunction Guidelines [7,8].…”