The impact of serial prostate biopsies on sexual function in men on active surveillance for prostate cancer

Joan F. Hilton, Sarah D. Blaschko, Jared M Whitson, Janet E. Cowan, Peter R. Carroll

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Purpose: NCCN Guidelines® recommend annual prostate biopsies for men with low risk prostate cancer on active surveillance. We determined whether erectile function decreases with the number of biopsies experienced. Materials and Methods: During a median 3.2-year followup after prostate cancer diagnosis in 2003 to 2010 at our institution 427 men on active surveillance underwent a total of 1,197 biopsies and provided 1,398 erectile function evaluations via the Sexual Health Inventory for Men questionnaire. For analysis we decomposed the 25-point questionnaire responses into a 5-point erectile function score and a 3-level sexual activity status. We used separate models adjusted for patient characteristics to determine whether either outcome varied with biopsy exposure. Results: At diagnosis the median age was 61 years and median prostate specific antigen was 5.3 ng/ml. Of the cases 70% were clinical stage cT1 and 93% were Gleason score less than 7. Of biopsies followed by evaluations 40% were the first undergone by the patient and 9% were the fifth to ninth. At the first erectile function evaluation 15% of men were inactive, 8% engage in stimulation and 77% engaged in intercourse. Sexual activity level changed in greater than 20% of respondents between evaluations. Adjusted erectile function scores were not associated with biopsy exposure cross-sectionally or longitudinally but they corresponded with the 50th, 63rd and 80th percentiles of erectile function by increasing sexual activity level. Similarly, sexual activity was not associated with biopsy exposure. Separated outcomes were more accurate and informative than Sexual Health Inventory for Men scores. Conclusions: Our study had high power to detect erectile function-biopsy associations but it estimated that the effects were negligible. We recommend erectile function scores over Sexual Health Inventory for Men scores to avoid biased assessment of erectile function.

Original languageEnglish (US)
Pages (from-to)1252-1258
Number of pages7
JournalJournal of Urology
Volume188
Issue number4
DOIs
StatePublished - Oct 2012
Externally publishedYes

Fingerprint

Prostate
Prostatic Neoplasms
Biopsy
Sexual Behavior
Reproductive Health
Equipment and Supplies
Neoplasm Grading
Prostate-Specific Antigen
Guidelines
Surveys and Questionnaires

Keywords

  • biopsy
  • erectile dysfunction
  • prostate
  • prostatic neoplasms
  • questionnaires

ASJC Scopus subject areas

  • Urology

Cite this

The impact of serial prostate biopsies on sexual function in men on active surveillance for prostate cancer. / Hilton, Joan F.; Blaschko, Sarah D.; Whitson, Jared M; Cowan, Janet E.; Carroll, Peter R.

In: Journal of Urology, Vol. 188, No. 4, 10.2012, p. 1252-1258.

Research output: Contribution to journalArticle

Hilton, Joan F. ; Blaschko, Sarah D. ; Whitson, Jared M ; Cowan, Janet E. ; Carroll, Peter R. / The impact of serial prostate biopsies on sexual function in men on active surveillance for prostate cancer. In: Journal of Urology. 2012 ; Vol. 188, No. 4. pp. 1252-1258.
@article{fea4b604a2ec47cebd6d663169c5e225,
title = "The impact of serial prostate biopsies on sexual function in men on active surveillance for prostate cancer",
abstract = "Purpose: NCCN Guidelines{\circledR} recommend annual prostate biopsies for men with low risk prostate cancer on active surveillance. We determined whether erectile function decreases with the number of biopsies experienced. Materials and Methods: During a median 3.2-year followup after prostate cancer diagnosis in 2003 to 2010 at our institution 427 men on active surveillance underwent a total of 1,197 biopsies and provided 1,398 erectile function evaluations via the Sexual Health Inventory for Men questionnaire. For analysis we decomposed the 25-point questionnaire responses into a 5-point erectile function score and a 3-level sexual activity status. We used separate models adjusted for patient characteristics to determine whether either outcome varied with biopsy exposure. Results: At diagnosis the median age was 61 years and median prostate specific antigen was 5.3 ng/ml. Of the cases 70{\%} were clinical stage cT1 and 93{\%} were Gleason score less than 7. Of biopsies followed by evaluations 40{\%} were the first undergone by the patient and 9{\%} were the fifth to ninth. At the first erectile function evaluation 15{\%} of men were inactive, 8{\%} engage in stimulation and 77{\%} engaged in intercourse. Sexual activity level changed in greater than 20{\%} of respondents between evaluations. Adjusted erectile function scores were not associated with biopsy exposure cross-sectionally or longitudinally but they corresponded with the 50th, 63rd and 80th percentiles of erectile function by increasing sexual activity level. Similarly, sexual activity was not associated with biopsy exposure. Separated outcomes were more accurate and informative than Sexual Health Inventory for Men scores. Conclusions: Our study had high power to detect erectile function-biopsy associations but it estimated that the effects were negligible. We recommend erectile function scores over Sexual Health Inventory for Men scores to avoid biased assessment of erectile function.",
keywords = "biopsy, erectile dysfunction, prostate, prostatic neoplasms, questionnaires",
author = "Hilton, {Joan F.} and Blaschko, {Sarah D.} and Whitson, {Jared M} and Cowan, {Janet E.} and Carroll, {Peter R.}",
year = "2012",
month = "10",
doi = "10.1016/j.juro.2012.06.013",
language = "English (US)",
volume = "188",
pages = "1252--1258",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - The impact of serial prostate biopsies on sexual function in men on active surveillance for prostate cancer

AU - Hilton, Joan F.

AU - Blaschko, Sarah D.

AU - Whitson, Jared M

AU - Cowan, Janet E.

AU - Carroll, Peter R.

PY - 2012/10

Y1 - 2012/10

N2 - Purpose: NCCN Guidelines® recommend annual prostate biopsies for men with low risk prostate cancer on active surveillance. We determined whether erectile function decreases with the number of biopsies experienced. Materials and Methods: During a median 3.2-year followup after prostate cancer diagnosis in 2003 to 2010 at our institution 427 men on active surveillance underwent a total of 1,197 biopsies and provided 1,398 erectile function evaluations via the Sexual Health Inventory for Men questionnaire. For analysis we decomposed the 25-point questionnaire responses into a 5-point erectile function score and a 3-level sexual activity status. We used separate models adjusted for patient characteristics to determine whether either outcome varied with biopsy exposure. Results: At diagnosis the median age was 61 years and median prostate specific antigen was 5.3 ng/ml. Of the cases 70% were clinical stage cT1 and 93% were Gleason score less than 7. Of biopsies followed by evaluations 40% were the first undergone by the patient and 9% were the fifth to ninth. At the first erectile function evaluation 15% of men were inactive, 8% engage in stimulation and 77% engaged in intercourse. Sexual activity level changed in greater than 20% of respondents between evaluations. Adjusted erectile function scores were not associated with biopsy exposure cross-sectionally or longitudinally but they corresponded with the 50th, 63rd and 80th percentiles of erectile function by increasing sexual activity level. Similarly, sexual activity was not associated with biopsy exposure. Separated outcomes were more accurate and informative than Sexual Health Inventory for Men scores. Conclusions: Our study had high power to detect erectile function-biopsy associations but it estimated that the effects were negligible. We recommend erectile function scores over Sexual Health Inventory for Men scores to avoid biased assessment of erectile function.

AB - Purpose: NCCN Guidelines® recommend annual prostate biopsies for men with low risk prostate cancer on active surveillance. We determined whether erectile function decreases with the number of biopsies experienced. Materials and Methods: During a median 3.2-year followup after prostate cancer diagnosis in 2003 to 2010 at our institution 427 men on active surveillance underwent a total of 1,197 biopsies and provided 1,398 erectile function evaluations via the Sexual Health Inventory for Men questionnaire. For analysis we decomposed the 25-point questionnaire responses into a 5-point erectile function score and a 3-level sexual activity status. We used separate models adjusted for patient characteristics to determine whether either outcome varied with biopsy exposure. Results: At diagnosis the median age was 61 years and median prostate specific antigen was 5.3 ng/ml. Of the cases 70% were clinical stage cT1 and 93% were Gleason score less than 7. Of biopsies followed by evaluations 40% were the first undergone by the patient and 9% were the fifth to ninth. At the first erectile function evaluation 15% of men were inactive, 8% engage in stimulation and 77% engaged in intercourse. Sexual activity level changed in greater than 20% of respondents between evaluations. Adjusted erectile function scores were not associated with biopsy exposure cross-sectionally or longitudinally but they corresponded with the 50th, 63rd and 80th percentiles of erectile function by increasing sexual activity level. Similarly, sexual activity was not associated with biopsy exposure. Separated outcomes were more accurate and informative than Sexual Health Inventory for Men scores. Conclusions: Our study had high power to detect erectile function-biopsy associations but it estimated that the effects were negligible. We recommend erectile function scores over Sexual Health Inventory for Men scores to avoid biased assessment of erectile function.

KW - biopsy

KW - erectile dysfunction

KW - prostate

KW - prostatic neoplasms

KW - questionnaires

UR - http://www.scopus.com/inward/record.url?scp=84866115494&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866115494&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2012.06.013

DO - 10.1016/j.juro.2012.06.013

M3 - Article

C2 - 22902015

AN - SCOPUS:84866115494

VL - 188

SP - 1252

EP - 1258

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 4

ER -