Associations of sexual dysfunction symptoms with PSA-detected localised and advanced prostate cancer: A case-control study nested within the UK population-based ProtecT (Prostate testing for cancer and Treatment) study

Collin, Simon M.; Metcalfe, Chris; Donovan, Jenny L.; Athene Lane, J.; Davis, Michael; Neal, David E.; Hamdy, Freddie C.; Martin, Richard M.

doi:10.1016/j.ejca.2009.05.021

« Previous Next »European Journal of Cancer
Volume 45, Issue 18 , Pages 3254-3261, December 2009

Associations of sexual dysfunction symptoms with PSA-detected localised and advanced prostate cancer: A case-control study nested within the UK population-based ProtecT (Prostate testing for cancer and Treatment) study

Simon M. Collin
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- Corresponding author: Tel.: +44 0117 3313934; fax: +44 0117 9287292.
Chris Metcalfe
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
Jenny L. Donovan
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
J. Athene Lane
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
Michael Davis
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
David E. Neal
- Department of Oncology, University of Cambridge, P.O. Box 279 (S4), Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
Freddie C. Hamdy
- Nuffield Department of Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
Richard M. Martin
- Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK

Received 23 March 2009; received in revised form 12 May 2009; accepted 15 May 2009. published online 22 June 2009.

Abstract

Background

Sexual dysfunction might be symptomatic of cancer spreading beyond the prostate by local invasion, a mechanism of tumour progression associated with prognosis. Conversely, among men with raised prostate-specific antigen (PSA) levels, a negative association might be expected if sexual dysfunction was symptomatic of benign, rather than malignant, prostatic disease.

Patients and methods

Cases and controls were selected from among men recruited to the UK population-based ProtecT (Prostate testing for cancer and Treatment) study. Men aged 50–69years were invited for PSA testing and those with a PSA level ⩾3.0ng/ml were invited for biopsy. We investigated whether symptoms of sexual dysfunction, determined by self-completed questionnaire prior to biopsy, were associated with prostate cancer.

Results

Of the 8924 men who had a PSA level ⩾3.0ng/ml (11% of the men who had a PSA test), 6585 underwent biopsy of whom 2813 and 421, respectively, were subsequently diagnosed with localised and advanced prostate cancer and 3351 had a negative biopsy result. No individual symptom of sexual dysfunction was associated with risk of prostate cancer. The symptom score was associated with advanced (odds ratio (OR) per one unit increase in score=1.06; 1.00–1.12; P=0.07) but not with localised (OR=1.00; 0.97–1.02; P=0.9) prostate cancer (P=0.05 for heterogeneity).

Conclusions

Our study provides weak evidence that sexual dysfunction may be associated with PSA-detected advanced, but not localised, prostate cancer among men with raised PSA levels.

Keywords: Prostate cancer, Prostate-specific antigen, Sexual dysfunction