Anissa V. Bailey

Objectives: Our objective was to evaluate patient‐reported sexual function (SF) outcomes and sexual aid use 12 months after curative treatment for prostate cancer (PC). Patients & Methods: This prospective registry‐based cohort study analysed men with localized or locally advanced PC enrolled in the TrueNTH Global Registry. Patients with baseline and 12‐month patient‐reported outcome measures after radical prostatectomy (RP), external beam radiotherapy (EBRT) ± androgen‐deprivation therapy (ADT), or brachytherapy (BT) were included. SF was assessed using the EPIC‐26 sexual function domain score (SFDS). Baseline and 12‐month EPIC‐26 SFDS were compared by treatment group, with additional analyses among RP patients examining outcomes by intent to nerve spare and sexual aid use. Linear regression, adjusted for age, National Comprehensive Cancer Network risk group, baseline SFDS, and intent to nerve spare was used to identify predictors of 12‐month SFDS among surgery patients. Results: Overall, 13 413 men were analysed (RP 85.2%, EBRT only 9.1%, EBRT+ADT 4.3%, BT 1.3%). SF declined significantly across all modalities. Median SFDS reduction was greatest after RP (−60.0%) and smallest after BT (−40.2%). At 12 months, poor or absent erectile function was reported by 63.6–91.8% of patients, highest after RP and EBRT+ADT. Sexual aid use increased after treatment but remained low overall. Given the retrospective design and non‐representative sites in an international registry setting, these findings should be interpreted as associational rather than causal because of the potential for unmeasured confounding and cross‐country heterogeneity in treatment selection. Conclusion: All curative PC treatments were associated with substantial deterioration in SF. These findings support enhanced pre‐treatment counselling and early integration of proactive management and structured sexual rehabilitation into survivorship care.

Background: Men seeking care in the Veterans Health Administration (VHA) may have higher prostate cancer (PCa) incidence, metastases, and mortality (PCSM) relative to the general US population due to military exposures and increased access to care. We compared rates in both populations using contemporary databases. Methods: Annual PCa incidence, metastasis, and PCSM rates between 2008 and 2022 were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program and calculated from the VA Multi-OMICS Analysis Platform for Prostate Cancer (VA-MAPP) database. Age-adjusted rates per 100,000 were standardized to the veteran’s age distribution and stratified by race/ethnicity and age group (<50, 50-64, 65+ years). Joinpoint regression was used to evaluate trends in rates following changes in United States Preventive Services Task Force (USPSTF) screening recommendations. Results: PCa incidence and PCSM rates were higher in the VHA vs SEER (RR2018-2022: 3.34, 95% CI: 3.32-3.36). However, metastatic rates were lower in the VHA compared to SEER (RR2018-2022: 0.69, 95% CI: 0.67-0.71). PCa incidence declined in the VHA (APC2008-2011: 7.3, 95% CI: 5.0-9.6) and SEER (APC2008-2011: 3.2, 95% CI: 0.7-5.6) prior to USPSTF 2012 guidelines, but metastatic rates increased in the VHA (APC2012-2017: 4.6, 95% CI: 2.1-7.1) and SEER (APC2012-2017: 3.3, 95% CI: 1.5-5.3), followed by general flattening of incidence, metastasis, and PCSM in both groups. Conclusions: Higher PCa incidence and PCSM was observed in VHA compared to SEER, but not metastasis. Impact: Increased access to care could explain higher incidence but more favorable metastatic presentation in VHA compared to SEER.

Purpose: Micro-ultrasound (micro-US) has been shown to have equivalent prostate cancer detection to MRI. However, unlike Prostate Imaging Reporting and Data System (PI-RADS), the PRI-MUS system does not use tumor size to distinguish between 4 and 5 lesions. Reliance solely on acoustic features may lead to variability in interpretation among operators and suboptimal cancer detection rates. In this study, we aimed to evaluate whether sagittal length improves the cancer detection rates for PRI-MUS 4 and 5 lesions. Materials and Methods: We evaluated 275 PRI-MUS 5 and 5 lesions from men who underwent micro-ultrasound–guided biopsy at the University of California, Los Angeles (UCLA) medical center. Micro-US sagittal length was used as a differentiating factor between PRI-MUS 4 and 5 lesions by determining the Positive predictive value (PPV) at multiple thresholds. Chi-square analysis was used to compare the PPV of PRI-MUS version1 (V1) and PRI-MUS version2 (V2) for Grade Group ≥ 2 prostate cancer. Results: PPV of micro-US for PRI-MUS V1 4 and 5 lesions was 50.9% and 85.5%, respectively. Using a threshold of 2 cm, the PPV of micro-US for the PRI-MUS V2 4 and 5 scoring system was 60.3% and 88.4%. This corresponds to a slight increase of 2.9% in PPV for lesions with a score of 5 and a 9.4% increase for lesions assigned a PRI-MUS score of 4 ( P = .06). Conclusion: This study proposes sagittal length as an objective criterion for lesion classification, with a threshold of 2.0 cm for PRI-MUS 5 upgrading. This approach improves the PPV of PRI-MUS 4 lesions by approximately 10% while preserving the PPV of PRI-MUS 5 lesions.

PURPOSE: Functional problems such as incontinence and sexual dysfunction after radical prostatectomy (RP) are important outcomes to evaluate surgical quality in prostate cancer (PC) care. Differences in survival after RP between countries are known, but differences in functional outcomes after RP between providers from different countries are not well described. METHODS: Data from a multinational database of patients with PC (nonmetastatic, treated by RP) who answered the EPIC-26 questionnaire at baseline (before RP, T0) and 1 year after RP (T1) were used, linking survey data to clinical information. Casemix-adjusted incontinence and sexual function scores (T1) were calculated for each country and provider on the basis of regression models and then compared using minimally important differences (MIDs). RESULTS: A total of 21,922 patients treated by 151 providers from 10 countries were included. For the EPIC-26 incontinence domain, the median adjusted T1 score of countries was 76, with one country performing more than one MID (for incontinence: 6) worse than the median. Eighteen percent of the variance ( R²) of incontinence scores was explained by the country of the providers. The median adjusted T1 score of sexual function was 33 with no country performing perceivably worse than the median (more than one MID worse), and 34% ( R²) of the variance of the providers' scores could be explained by country. CONCLUSION: To our knowledge, this is the first comparison of functional outcomes 1 year after surgical treatment of patients with PC between different countries. Country is a relevant predictor for providers' incontinence and sexual function scores. Although the results are limited because of small samples from some countries, they should be used to enhance cross-country initiatives on quality improvement in PC care.