Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California 94107-1762, USA.
J Urol. 2012 Oct;188(4):1252-8. doi: 10.1016/j.juro.2012.06.013. Epub 2012 Aug 16.
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.
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.
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.
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.
NCCN 指南®建议对处于主动监测的低危前列腺癌患者每年进行前列腺活检。我们确定了勃起功能是否会随活检次数的增加而下降。
在我们机构 2003 年至 2010 年期间对处于主动监测的前列腺癌患者进行中位 3.2 年的随访后，427 名患者共进行了 1197 次活检，并通过男性性健康问卷（Sexual Health Inventory for Men，SHIM）提供了 1398 次勃起功能评估。为了分析，我们将 25 分问卷反应分解为 5 分勃起功能评分和 3 级性活动状态。我们使用单独的模型来调整患者特征，以确定这两个结果是否随活检暴露而变化。
在诊断时，中位年龄为 61 岁，中位前列腺特异性抗原为 5.3ng/ml。病例中 70%为临床分期 cT1，93%为 Gleason 评分小于 7。在接受评估的活检中，40%为患者首次接受，9%为第五至第九次。在第一次勃起功能评估中，15%的男性不活跃，8%进行刺激，77%进行性交。在评估之间，超过 20%的受访者的性活动水平发生了变化。调整后的勃起功能评分与活检暴露无论是在横断面还是在纵向都没有关联，但它们与勃起功能的第 50、63 和 80 百分位数相对应，因为性活动水平增加了。同样，性活动与活检暴露无关。分离的结果比男性性健康问卷（SHIM）评分更准确和有信息。
我们的研究有很高的检测勃起功能与活检关联的能力，但估计影响是微不足道的。我们建议使用勃起功能评分而不是男性性健康问卷（SHIM）评分，以避免对勃起功能的有偏差评估。
