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. 2021 Jun;10(6):2719-2727.
doi: 10.21037/tau-20-1255.

Using the Movember Foundation's GAP3 cohort to measure the effect of active surveillance on patient-reported urinary and sexual function-a retrospective study in low-risk prostate cancer patients

R Trafford Crump  1 , Sebastiaan Remmers  2 , Mieke Van Hemelrijck  3 , Jozien Helleman  2 , Daan Nieboer  2 , Monique J Roobol  2 , Lionne D F Venderbos  2 ; Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) consortium
Collaborators, Affiliations

Using the Movember Foundation's GAP3 cohort to measure the effect of active surveillance on patient-reported urinary and sexual function-a retrospective study in low-risk prostate cancer patients

R Trafford Crump et al. Transl Androl Urol. 2021 Jun.

Abstract

Background: Active surveillance (AS) for low-risk prostate cancer (PCa) is intended to overcome potential side-effects of definitive treatment. Frequent prostate biopsies during AS may, however, impact erectile (EF) and urinary function (UF). The objective of this study was to test the influence of prostate biopsies on patient-reported EF and UF using multicenter data from the largest to-date AS-database.

Methods: In this retrospective study, data analyses were performed using the Movember GAP3 database (v3.2), containing data from 21,169 AS participants from 27 AS-cohorts worldwide. Participants were included in the study if they had at least one follow-up prostate biopsy and completed at least one patient reported outcome measure (PROM) related to EF [Sexual Health Inventory for Men (SHIM)/five item International Index of Erectile Function (IIEF-5)] or UF [International Prostate Symptom Score (IPSS)] during follow-up. The longitudinal effect of the number of biopsies on either SHIM/IIEF-5 or IPSS were analyzed using linear mixed models to adjust for clustering at patient-level. Analyses were stratified by center; covariates included age and Gleason Grade group at diagnosis, and time on AS.

Results: A total of 696 participants completed the SHIM/IIEF-5 3,175 times, with a median follow-up of 36 months [interquartile range (IQR) 20-55 months]. A total of 845 participants completed the IPSS 4,061 times, with a median follow-up of 35 months (IQR 19-56 months). The intraclass correlation (ICC) was 0.74 for the SHIM/IIEF-5 and 0.68 for the IPSS, indicating substantial differences between participants' PROMs. Limited heterogeneity between cohorts in the estimated effect of the number of biopsies on either PROM were observed. A significant association was observed between the number of biopsies and the SHIM/IIEF-5 score, but not for the IPSS score. Every biopsy was associated with a decrease in the SHIM/IIEF-5 score of an average 0.67 (95% CI, 0.47-0.88) points.

Conclusions: Repeated prostate biopsy as part of an AS protocol for men with low-risk PCa does not have a significant association with self-reported UF but does impact self-reported sexual function. Further research is, however, needed to understand whether the effect on sexual function implies a negative clinical impact on their quality of life and is meaningful from a patient's perspective. In the meantime, clinicians and patients should anticipate a potential decline in erectile function and hence consider incorporating the risk of this harm into their discussion about opting for AS and also when deciding on the stringency of follow-up biopsy schedules with long-term AS.

Keywords: International Prostate Symptom Score (IPSS); Prostate cancer (PCa); Sexual Health Inventory for Men (SHIM); five item International Index of Erectile Function (IIEF-5); patient-reported outcome.

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Conflict of interest statement

Conflicts of Interest: The authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tau-20-1255). The series “Expectant Management in Genitourinary Malignancies (Prostate, Bladder, Kidney)” was commissioned by the editorial office without any funding or sponsorship. Dr. MVH served as the unpaid Guest Editor of the series. Dr. MJR serves as an unpaid Associate Editor-in-Chief of Translational Andrology and Urology from Jan 2020 to Dec 2021. Dr. JH reports grants from the Movember Foundation, during the conduct of the study. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Coefficients of the number of biopsies on urinary functioning measured by the IPSS, n represent number of questionnaires completed. The effect of the number of biopsies on urinary functioning is controlled for age at diagnosis, time on AS and the Gleason score at diagnosis. AS, active surveillance.
Figure 2
Figure 2
Coefficients of the number of biopsies on erectile functioning (SHIM/IIEF-5), n represent number of questionnaires completed. The effect of the number of biopsies on erectile functioning is controlled for age at diagnosis, time on AS and the Gleason score at diagnosis. AS, active surveillance.
See this image and copyright information in PMC

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