PURPOSE: Active surveillance (AS) is becoming an increasingly common management strategy for low-grade prostate cancer and involves repeated prostate biopsies over time.
It has been hypothesized that serial biopsies can lead to reduced erectile function (EF) in patients on AS. We explored this hypothesis in a longitudinally followed cohort.
MATERIALS AND METHODS: We identified 342 men on AS whose first biopsy occurred between 2000 and 2009. We investigated EF using patient-reported outcomes, namely the six erectile function questions from the International Index of Erectile Function (IIEF-6). We estimated the change in EF over time using locally-weighted scatterplot smoothing.
RESULTS: The median age in this cohort was 64 (IQR 58-68) years. Median follow-up on AS was 3.5 years (IQR 2.3-5.0), and the median number of biopsies was 5 (IQR 3-6). Over the first 4 years on AS, EF declined 1.0 points/year (95% confidence interval [CI], 0.2, 1.7) on the IIEF-6 (scale 1-30). When stratified by comorbidities or number of biopsies, we see an almost identical drop in EF over time. The use of Phosphodiesterase-5 inhibitors increased from 5% to 27% from baseline to year 5 on AS.
CONCLUSION: In this longitudinally followed active surveillance cohort we observed a small decline of erectile function and an increased use of Phosphodiesterase-5 inhibitors over time. While we cannot separate out the effect of multiple biopsies from that of the natural aging process on erectile function in this observational study, our data suggests AS-related biopsies do not have a large impact on erectile function.
Written by:
Braun K, Ahallal Y, Sjoberg DD, Ghoneim T, Dominguez Esteban M, Mulhall J, Vickers A, Eastham J, Scardino PT, Touijer KA. Are you the author?
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Urology, University Hospital Ruhr University Bochum, Marienhospital Herne, Widumerstrasse 8, 44627 Herne, Germany.
Reference: J Urol. 2013 Sep 4. pii: S0022-5347(13)05301-9.
doi: 10.1016/j.juro.2013.08.054
PubMed Abstract
PMID: 24012535
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