Erectile and urinary function in patients on active surveillance for prostate cancer: results from the Finnish arm of the PRIAS trial

Objective: To evaluate longitudinal changes in urinary function (UF) and erectile function (EF) in a prospective active surveillance (AS) cohort of men with low-risk prostate cancer (PC), and to correlate urinary and sexual satisfaction with quality of life (QoL). Material and methods: The final cohort consisted of 359 men from the Finnish arm of the Prostate Cancer Research International: Active Surveillance (PRIAS) trial. Erectile function was assessed using the International Index of Erectile Function (IIEF-15) questionnaire and UF using the International Prostate Symptom Score (IPSS) questionnaire at baseline and at 1, 3, 5, 7, 9, 11, 13, and 15 years. Correlation analyses were performed between EF, UF, and QoL. Factors influencing EF and UF, including age, prostate-specific antigen (PSA), prostate volume, and number of biopsies, were analysed. Results: In all, 255 (71%) men completed the IIEF-15 and 262 (73%) the IPSS questionnaires at baseline and at least once during follow-up. The median IIEF-15 score at baseline was 56 (interquartile range [IQR] 28–65), decreasing to 42 (IQR 12–62) after 5 years. Median IPSS scores increased from 7 (4–13 IQR) at baseline to 10 (5.5–14.5 IQR) at 3 years. Overall sexual satisfaction and IPSS QoL remained stable throughout follow-up. Conclusion: AS did not cause short-term disturbances in EF or UF, as measured by standardised IIEF-15 and IPSS questionnaires. Although EF and UF significantly declined over the longest follow-up reported in the literature, overall sexual satisfaction and urinary QoL remained unaffected, suggesting that functional deterioration did not substantially impact patient-perceived QoL during AS.