Sexual function with localized prostate cancer: active surveillance vs radical therapy

Area of Science:

• Urology
• Oncology
• Men's Health

Background:

• Prostate cancer (PCa) management involves active surveillance (AS) or radical treatments like radical prostatectomy (RP) and radiation therapy (RT).
• Sexual dysfunction is a significant concern for men treated for localized PCa.
• Limited comparative data exists on sexual function outcomes between AS and radical therapies.

Purpose of the Study:

• To compare sexual function in men with localized PCa managed with AS versus those treated with RP or RT.
• To assess differences in sexual activity, erectile dysfunction, and erection difficulties between treatment groups.

Main Methods:

• A cohort study comparing men with localized PCa on AS (Prostate Cancer Research International: Active Surveillance) with men who received RP or RT (European Randomized Study of Screening for Prostate Cancer).
• Sexual function, mental health (Short-Form 12), depression (CES-D), and anxiety (STAI) were assessed using questionnaires at 6 and 12-18 months post-diagnosis/treatment.
• Multivariable analysis adjusted for baseline differences to compare outcomes between groups.

Main Results:

• A higher percentage of men on AS (65-68%) were sexually active compared to those undergoing RP (35-36%) or RT (36-37%).
• Erectile dysfunction was less common in the AS group (20-30%) compared to RP (86-91%) and RT (56-60%) groups.
• Among sexually active men, erection difficulties were reported less frequently by AS patients (44-51%) than by RP (96%) or RT (73-76%) patients.

Conclusions:

• Men with localized PCa on AS demonstrate superior sexual function compared to those receiving radical therapies, particularly RP.
• Lower rates of sexual inactivity due to erectile dysfunction and fewer erection problems in sexually active AS patients were observed.
• The non-randomized nature of the study and advancements in RP/RT techniques may influence future findings.