title: The Evolution of Self-Reported Urinary and Sexual Dysfunction over the Last Two Decades: Implications for Comparative Effectiveness Research.
abstract: BACKGROUND
  Despite the paramount importance of patient-reported outcomes, little is known about the evolution of patient-reported urinary and sexual function over time.
  
  
  OBJECTIVE
  To evaluate differences in pretreatment urinary and sexual function in two population-based cohorts of men with prostate cancer enrolled nearly 20 yr apart.
  
  
  METHODS
  Patients were enrolled in the Prostate Cancer Outcomes Study (PCOS) or the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study, two population-based cohorts that enrolled patients with incident prostate cancer from 1994 to 1995 and from 2011 to 2012, respectively. Participants completed surveys at baseline and various time points thereafter.
  
  
  METHODS
  We performed multivariable logistic and linear regression analysis to investigate differences in pretreatment function between studies.
  
  
  CONCLUSIONS
  The study comprised 5469 men of whom 2334 (43%) were enrolled in PCOS and 3135 (57%) were enrolled in CEASAR. Self-reported urinary incontinence was higher in CEASAR compared with PCOS (7.7% vs 4.7%; adjusted odds ratio [OR]: 1.83; 95% confidence interval [CI], 1.39-2.43). Similarly, self-reported erectile dysfunction was more common among CEASAR participants (44.7% vs 24.0%) with an adjusted OR of 3.12 (95% CI, 2.68-3.64). Multivariable linear regression models revealed less favorable self-reported baseline function among CEASAR participants in the urinary incontinence and sexual function domains. The study is limited by its observational design and possibility of unmeasured confounding.
  
  
  CONCLUSIONS
  Reporting of pretreatment urinary incontinence and erectile dysfunction has increased over the past two decades. These findings may reflect sociological changes including heightened media attention and direct-to-consumer marketing, among other potential explanations.
  
  
  RESULTS
  Patient reporting of urinary and sexual function has evolved and is likely contingent on continually changing societal norms. Recognizing the evolving nature of patient reporting is essential in efforts to conduct high-quality, impactful comparative effectiveness research.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA. Electronic address: Matthew.Resnick@vanderbilt.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Resnick
authors.affiliation: Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.affiliation: Department of Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Alicia K
authors.initials: AK
authors.lastname: Morgans
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, TN, USA.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Phillips
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, TN, USA.
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Koyama
authors.affiliation: Division of Urology, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Albertsen
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
authors.affiliation: Department of Epidemiology, Emory University, Atlanta, GA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Department of Medicine, University of California, Irvine, Irvine, CA, USA.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Greenfield
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
authors.affiliation: Department of Medicine, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
authors.affiliation: Department of Medicine, University of California, Irvine, Irvine, CA, USA.
authors.forename: Sherrie H
authors.initials: SH
authors.lastname: Kaplan
authors.affiliation: Eskind Biomedical Library, Vanderbilt University, Nashville, TN, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: McCollum
authors.affiliation: New Jersey State Cancer Registry, Trenton, NJ, USA.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Paddock
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Stanford
authors.affiliation: New Jersey State Cancer Registry, Trenton, NJ, USA.
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Stroup
authors.affiliation: Louisiana State University Health Sciences Center, New Orleans, LA, USA.
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
authors.affiliation: Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D057186:Comparative Effectiveness Research / Q000379:methods / Q000706:statistics & numerical data; D007172:Erectile Dysfunction / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects*; D012044:Regression Analysis; D012307:Risk Factors; D057566:Self Report; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology*
keywords: Patient-reported outcomes; Prostate cancer; Quality of life; Sexual function; Urinary function