Sexual function outcomes following interventions for prostate cancer: are contemporary reports on functional outcomes misleading?

Patients with primary localised prostate cancer (PCa) have a wide choice of curative therapeutic interventions, including active surveillance, surgical, focal and radiation therapies. Based on clinical and oncological characteristics, treatment decisions entail consideration of oncological and functional outcomes with important effects on quality of life. We aimed to highlight evidence surrounding present inconsistencies, the problems this presents to clinicians and patients alike and the rationale for using return to baseline as a more realistic and objective functional outcome measure for assessing sexual function in this particularly sensitive group of men. We performed a non-systematic literature review of numerous non-validated, arbitrary thresholds employed in evaluation of sexual function outcomes in men undergoing intervention for primary localised PCa. The literature presents much heterogeneity in measurement methods and outcome measures, which lack context and present difficulties when counselling patients to make informed, autonomous decisions. These include findings from the most widely used internationally validated tools, such as the International Index of Erectile Function (IIEF), UCLA prostate cancer index and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (QLQ-C30). There is a need for standardisation of reporting outcomes following PCa treatment to facilitate evaluation of existing and emerging technologies.