title: A Longitudinal Study of Predictors of Sexual Dysfunction in Men on Active Surveillance for Prostate Cancer.
abstract: OBJECTIVE
  The aim of this study was to examine the relationship between sexual dysfunction, repeat biopsies and other demographic and clinical factors in men on active surveillance (AS).
  
  
  METHODS
  Patient-reported outcomes (PROs) measures were administered at enrollment and every 6 months to assess quality of life (QOL), psychosocial and urological health outcomes. Using mixed-effects models, we examined the impact of repeat biopsies, total number of cores taken, anxiety, age, and comorbidity on sexual function over the first 24 months of enrolling in AS.
  
  
  METHODS
  PROs included the Expanded Prostate Cancer Index Composite-26 (EPIC-26) Sexual Function (SF) subscale, the American Urological Association-Symptom Index (AUA-SI), and the Memorial Anxiety Scale for Prostate Cancer (MAX-PC).
  
  
  RESULTS
  At enrollment (n = 195), mean age was 66.5 ± 6.8 with a mean EPIC-26 SF score of 61.4 ± 30.4. EPIC-26 SF scores steadily decreased to 53.9 ± 30.7 at 24 months (P < 0.01). MAX-PC scores also progressively decreased over time (P = 0.03). Factors associated with lower EPIC-26 scores over time included age, unemployed status, diabetes, coronary artery disease, and hypertension (all P < 0.05). Higher prostate-specific antigen (PSA) was associated with a more rapid decline in EPIC-26 SF over time (P = 0.03). In multivariable analysis, age, diabetes, and PSA × time interaction remained significant predictors of diminished sexual function. Anxiety, number of biopsies, and total cores taken did not predict sexual dysfunction or change over time in our cohort.
  
  
  CONCLUSIONS
  Men on AS experienced a gradual decline in sexual function during the first 24 months of enrollment. Older age, PSA × time, and diabetes were all independent predictors of diminished sexual function over time. Anxiety, AUA-SI, the number of cores and the number of biopsies were not predictors of reduced sexual function in men in AS.
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago Medicine and Biological Sciences Chicago, IL, USA.
authors.forename: Shane M
authors.initials: SM
authors.lastname: Pearce
authors.affiliation: Department of Surgery, NorthShore University HealthSystem Evanston, IL, USA.
authors.forename: Chi-Hsiung E
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine Chicago, IL, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Victorson
authors.affiliation: Department of Surgery, NorthShore University HealthSystem Evanston, IL, USA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Helfand
authors.affiliation: Department of Surgery, NorthShore University HealthSystem Evanston, IL, USA.
authors.forename: Kristian R
authors.initials: KR
authors.lastname: Novakovic
authors.affiliation: Department of Surgery, NorthShore University HealthSystem Evanston, IL, USA.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Brendler
authors.affiliation: Department of Surgery, NorthShore University HealthSystem Evanston, IL, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Albaugh
keywords: Active Surveillance; Erectile Dysfunction; Prostate Cancer; Quality of Life; Sexual Dysfunction