Prostate Cancer Patient Characteristics Associated With a Strong Preference to Preserve Sexual Function and Receipt of Active Surveillance

Broughman, James R.; Basak, Ramsankar; Nielsen, Matthew E.; Reeve, Bryce B.; Usinger, Deborah S.; Spearman, K.; Godley, Paul A.; Chen, I‐Chun

doi:10.1093/jnci/djx218

Cited by 18 publications

(11 citation statements)

References 37 publications

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“…3,16,17 However, to the best of our knowledge, the impact of different types of surgery and RT on sexual function has not been well studied to date. It is well known that for many patients, preserving QOL is of high importance in the treatment decision-making process; specifically, prior studies have demonstrated that >50% of men consider the preservation of sexual function to be important.…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that for many patients, preserving QOL is of high importance in the treatment decision-making process; specifically, prior studies have demonstrated that >50% of men consider the preservation of sexual function to be important. 3,16,17 However, to the best of our knowledge, the impact of different types of surgery and RT on sexual function has not been well studied to date. To fill this knowledge gap, we analyzed data from a diverse, prospective, population-based cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

“…1 The majority of patients with prostate cancer have localized disease, and often have excellent survival outcomes after treatment with radical prostatectomy (RP) or radiotherapy (RT). 3 Both RP and RT are known to negatively impact sexual function, and some prior studies have shown that RP has an overall larger negative impact compared with RT. Specifically, many men with prostate cancer consider the preservation of sexual function to be a high priority.…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, many men with prostate cancer consider the preservation of sexual function to be a high priority. 3 Both RP and RT are known to negatively impact sexual function, and some prior studies have shown that RP has an overall larger negative impact compared with RT. [4][5][6] However, nerve-sparing RP is known to improve preservation of sexual function compared with the older non-nerve-sparing surgery, 7 and adding androgen deprivation therapy (ADT) to RT is known to worsen sexual function further.…”

Section: Introductionmentioning

confidence: 99%

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Patient‐reported sexual quality of life after different types of radical prostatectomy and radiotherapy: Analysis of a population‐based prospective cohort

Mullins

Basak

Broughman

et al. 2019

Cancer

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BACKGROUND: Although patients with prostate cancer face many treatment options, to the authors' knowledge the comparative effects of different surgical and radiotherapy (RT) options on sexual function are unclear. METHODS: In the current study, a population-based cohort of 835 men with newly diagnosed prostate cancer from 2011 through 2013 was recruited throughout North Carolina in collaboration with the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry. All men were enrolled prior to treatment and followed prospectively using the validated Prostate Cancer Symptom Indices (PCSI) instrument. This analysis compares the sexual dysfunction scores of the PCSI among patients who received external-beam RT (EBRT), EBRT with androgen deprivation therapy (ADT), brachytherapy, nerve-sparing radical prostatectomy (RP), and non-nerve-sparing RP. Propensity scores were used to balance patient characteristics across groups, and multiple imputation was used for missing data. RESULTS: EBRT and brachytherapy resulted in similar PCSI scores through 24 months. Compared with those receiving EBRT, patients treated with EBRT with ADT and RP with or without nerve sparing were found to have worse PCSI scores at all posttreatment time points. Preservation of useful sexual function at 24 months was associated with treatment type, baseline score, and age. Predicted preservation rates were 14.1% to 70.7% for EBRT, 8.4% to 52.3% for EBRT with ADT, 4.7% to 45.3% for nerve-sparing RP, and 4.8% to 34.5% for non-nerve-sparing RP. CONCLUSIONS: The findings of the current study indicate that RT alone results in the best preservation of sexual function, and brachytherapy provides similar outcomes. RT with ADT and nerve-sparing RP yielded similar outcomes, whereas patients treated with non-nerve-sparing RP experienced the worst sexual function. These results help patients to make decisions among the specific types of surgery and RT they face based on each individual's diagnosis. Cancer 2019;125:3657-3665.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patient‐reported sexual quality of life after different types of radical prostatectomy and radiotherapy: Analysis of a population‐based prospective cohort

Mullins

Basak

Broughman

et al. 2019

Cancer

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“…There are multiple treatment options for men with localized prostate cancer which provide similar curative efficacy but differ in their impact on health-related quality of life (HRQOL) 2 ; therefore, the latter is often an important consideration in patients’ decision-making process. Many patients with prostate cancer report that choosing a treatment which allows preservation of their sexual function is highly important 3 . For example, prostatectomy has been shown to reduce erectile functioning 4–7 .…”

Section: Introductionmentioning

confidence: 99%

Psychometric Evaluation of PROMIS Sexual Function and Satisfaction Measures in a Longitudinal Population-Based Cohort of Men With Localized Prostate Cancer

Reeve

Wang

Weinfurt

et al. 2018

The Journal of Sexual Medicine

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Background There are multiple treatment options for men with localized prostate cancer that provide similar curative efficacy but differ in their impact on sexual functioning. Aim This study evaluated the psychometric properties of the Patient-Reported Outcomes Measurement Information System® (PROMIS® ) Sexual Function and Satisfaction (SexFS) measures, including items from version 1 and 2 of the short forms. Methods A population-based cohort of men across North Carolina completed surveys via phone interviews at baseline (prior to treatment) and at 3-, 12-, and 24-months post cancer treatment initiation. Surveys included the PROMIS SexFS domains of Interest in Sexual Activity, Erectile Function, Orgasm, and Satisfaction and the Prostate Cancer Symptom Indices (PCSI). Analyses included descriptive statistics, assessment of factorial validity using confirmatory factor analysis (CFA) and item response theory (IRT), tests for differential item functioning, assessment of convergent validity using correlations, and evaluation of responsiveness of the PROMIS SexFS measures over time. We hypothesized that men undergoing surgery (prostatectomy) would report the poorest sexual function at 3-month survey. Results Sample size varied by assessment point and ranged from 332 to 939 men, consisting of 30% non-white men and 30% of sample with a high school degree or less. The items within the PROMIS orgasm domain did not associate together to form a unidimensional scale. PROMIS measures of Interest in Sexual Activity, Erectile Function, and Satisfaction were unidimensional and highly correlated with related PCSI measures (e.g., erectile function, r=0.84–0.95). Erectile Function in the Surgery group declined more at 3-months compared to the No-Surgery group (2 points); this difference narrowed at 12- and 24-months as the Surgery group recovered over time. Results were similar for PROMIS Interest in Sexual Activity and PROMIS Satisfaction scales. Clinical Implications The PROMIS SexFS measures may be used to identify effective interventions to treat sexual dysfunction and monitor sexual functioning in men with prostate cancer over time. Strengths & Limitations This study was limited to men living in North Carolina who could self-report their HRQOL in English. However, this study was able to include more men from vulnerable populations by allowing the men to self-report over the phone. Conclusion This study provided strong support for use of the PROMIS SexFS (version 2) measures in men with localized prostate cancer to assess sexual interest, erectile function and satisfaction over time.

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Factors impacting on sexual function among men on active surveillance for prostate cancer

et al. 2023

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Background: Active surveillance (AS) aims to reduce overtreatment and minimize the negative side effects of radical therapies (i.e., prostatectomy or radiotherapy) while preserving quality of life. However, a substantial proportion of men can experience a decline in sexual function during AS follow-up. The aim of this study was to identify predictors of declining sexual function among men on AS. Methods: Men enrolled from 2008 to 2018 in the South Australian Prostate Cancer Clinical Outcomes Collaborative registry-a prospective clinical registry-were studied. Sexual function outcomes were measured using expanded prostate cancer index composite (EPIC-26) at baseline and 12-months postdiagnosis. Multivariable regression models adjusted for baseline score and other sociodemographic and clinical factors were applied to identify predictors of sexual function score at 12-months. Results: A total of 554 men were included. Variables that showed significant association with decline in sexual function score at 12-months were: having two or more biopsies after diagnosis (mean change score (MCS): -16.3, p < 0.001) compared with no biopsy, higher number of positive biopsy cores (MCS: -1.6, p = 0.004), being in older age category (above 70 vs. below 60: MCS: -16.7, p < 0.001; 65−70 vs. below 60: MCS: -9.7, p = 0.024), having had depression (MCS: -9.0, p = 0.020), and impaired physical function (MCS: -10.0, p = 0.031). Greater socioeconomic advantage (highest vs. lowest quintile: MCS: 15.7, p = 0.022) and year of diagnosis (MCS: 2.6 for every year, p < 0.001) were positively associated with 12-months sexual function score. Neither biopsy type, biopsy timing nor PSA velocity were associated with declines in sexual function. Conclusions: Our findings suggest that multiple factors affected sexual function during AS. Interventions toward reducing the number of biopsies through less invasive monitory approaches, screening for physical and mental well-being, and targeted emotional support and counseling services may be helpful for men on AS.

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Prostate Cancer Patient Characteristics Associated With a Strong Preference to Preserve Sexual Function and Receipt of Active Surveillance

Abstract: Treatment choice may not always align with patients' preferences. These findings demonstrate opportunities to improve delivery of patient-centered care in early prostate cancer.

Cited by 18 publications

References 37 publications

Patient‐reported sexual quality of life after different types of radical prostatectomy and radiotherapy: Analysis of a population‐based prospective cohort

Patient‐reported sexual quality of life after different types of radical prostatectomy and radiotherapy: Analysis of a population‐based prospective cohort

Psychometric Evaluation of PROMIS Sexual Function and Satisfaction Measures in a Longitudinal Population-Based Cohort of Men With Localized Prostate Cancer

Factors impacting on sexual function among men on active surveillance for prostate cancer

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