The evolution of self-reported urinary and sexual dysfunction over the last two decades: Implications for comparative effectiveness research

Matthew J. Resnick*, Daniel A. Barocas, Alicia K. Morgans, Sharon E. Phillips, Tatsuki Koyama, Peter C. Albertsen, Matthew R. Cooperberg, Michael Goodman, Sheldon Greenfield, Ann S. Hamilton, Karen E. Hoffman, Richard M. Hoffman, Sherrie H. Kaplan, Dan McCollum, Lisa E. Paddock, Janet L. Stanford, Antoinette M. Stroup, Xiao Cheng Wu, David F. Penson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background Despite the paramount importance of patient-reported outcomes, little is known about the evolution of patient-reported urinary and sexual function over time. Objective To evaluate differences in pretreatment urinary and sexual function in two population-based cohorts of men with prostate cancer enrolled nearly 20 yr apart. Design, setting, and participants Patients were enrolled in the Prostate Cancer Outcomes Study (PCOS) or the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study, two population-based cohorts that enrolled patients with incident prostate cancer from 1994 to 1995 and from 2011 to 2012, respectively. Participants completed surveys at baseline and various time points thereafter. Outcome measurements and statistical analysis We performed multivariable logistic and linear regression analysis to investigate differences in pretreatment function between studies. Results and limitations The study comprised 5469 men of whom 2334 (43%) were enrolled in PCOS and 3135 (57%) were enrolled in CEASAR. Self-reported urinary incontinence was higher in CEASAR compared with PCOS (7.7% vs 4.7%; adjusted odds ratio [OR]: 1.83; 95% confidence interval [CI], 1.39-2.43). Similarly, self-reported erectile dysfunction was more common among CEASAR participants (44.7% vs 24.0%) with an adjusted OR of 3.12 (95% CI, 2.68-3.64). Multivariable linear regression models revealed less favorable self-reported baseline function among CEASAR participants in the urinary incontinence and sexual function domains. The study is limited by its observational design and possibility of unmeasured confounding. Conclusions Reporting of pretreatment urinary incontinence and erectile dysfunction has increased over the past two decades. These findings may reflect sociological changes including heightened media attention and direct-to-consumer marketing, among other potential explanations. Patient summary Patient reporting of urinary and sexual function has evolved and is likely contingent on continually changing societal norms. Recognizing the evolving nature of patient reporting is essential in efforts to conduct high-quality, impactful comparative effectiveness research.

Original languageEnglish (US)
Pages (from-to)1019-1025
Number of pages7
JournalEuropean urology
Issue number6
StatePublished - Jun 1 2015


  • Patient-reported outcomes
  • Prostate cancer
  • Quality of life
  • Sexual function
  • Urinary function

ASJC Scopus subject areas

  • Urology

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