Peyronie’s disease (PD) is a fibrotic disorder of the tunica albuginea that may result in penile deformity, pain, a palpable plaque, and erectile dysfunction. In order to understand the psycho-sexual impacts of PD on patients and their partners, we selected three online forums containing the largest number of threads on PD. Threads focusing on the psycho-sexual impacts posted from January 1, 2011 to January 1, 2021 were compiled, and thematic analysis was performed on Dedoose. There were 277 unique posters, including 225 patients and 52 partners. Eighty-four categories and five themes were developed including information and social support, physical symptoms, psycho-sexual symptoms, treatment and effect, and impacts on partners and relationship. Emotional distress including depressed mood ( n = 75, 33.3%) and feelings of isolation ( n = 41, 18.2%) was prevalent. Partners developed sexual dysfunction including sexual dissatisfaction ( n = 11, 21.2%) and dyspareunia ( n = 4, 7.7%). Relationships experienced disruption ( n = 14, 5.1%) or termination ( n = 10, 3.6%). Posters received psychological treatment including psychotherapy ( n = 20, 8.9%) and antidepressants ( n = 17, 7.6%). Of these, 12 reported improvement and 11 stated no improvement. On these forums, psychological burden affecting individuals with PD and their partners is reported. Few seek help from a psychologist or therapist, and psychological distress may persist even after successful PD treatment. Further research is needed to identify strategies for effective psychological management.

INTRODUCTION:Sexual pain is common among women but little is known about associations with exercise and physical activity. AIM:To determine the prevalence of sexual pain among physically active women and to evaluate cycling and other potential risk factors. METHODS:This is a secondary data analysis of a study on the urinary and sexual wellness of physically active women recruited through sporting clubs and targeted social media advertising. We used multivariable logistic regression to assess the role of cycling and exercise in reporting any, frequent, or severe sexual pain, controlling for demographic, relationship, and health risk factors. MAIN OUTCOME MEASURE:Sexual pain, including frequency and severity, was measured using the Female Sexual Function Index. RESULTS:A total of 2,039 women were included, with 1,097 (54%) reporting any level of sexual pain, 364 (18%) experiencing frequent pain, and 378 (19%) reporting severe pain. Less than 5% of women reported diabetes or hypertension, and the cohort had a median body mass index of 23.3 (interquartile range 21.4-25.7). Increasing age and body mass index were protective against any sexual pain, as was cycling (odds ratio [OR] 0.73 [95% CI 0.59-0.90]). Participants who reported being "moderately satisfied" (OR 0.53 [95% CI 0.31-0.91]) or "very satisfied" (OR 0.33 [95% CI 0.19-0.56]) with their emotional closeness to a sexual partner had decreased odds of any sexual pain. CONCLUSION:Experiencing any sexual pain is common in physically active women, with a prevalence of over 50%; however, weekly energy expenditure from exercise was not associated with sexual pain. Cycling participation and higher levels of emotional closeness and intimacy were associated with less pain. Patients between the ages of 18 and 30 years who were normal or underweight incurred the highest risk of sexual pain. Fergus KB, Cohen AJ, Cedars BE, et al. Risk Factors for Sexual Pain Among Physically Active Women. Sex Med 2020;8:501-509.

92 Background: Complementary and alternative medicine (CAM) use is common among prostate cancer (PCa) patients. The benefits and risks of the majority of CAM is inconclusive, and thus understanding trends in use is necessary to guide future research. We sought to investigate the prevalence of CAM use and trends in newly diagnosed PCa patients using the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). Methods: Between 1996-2017, 7,989 CaPSURE subjects completed questionnaires on use of over 50 CAM types. For prevalence, subjects were identified as users if they ever indicated CAM use. We then performed univariate analyses to examine associations between sociodemographic and clinical characteristics with CAM use using chi-squared tests. To observe trends in CAM use among newly diagnosed patients, we limited subject responses to questionnaires completed within 24 months of diagnosis (7,358 subjects). We then grouped subjects by diagnosis year and calculated percent change in use. Results: Overall, 56% of subjects reported any CAM use. Commonly used CAM were multivitamins (40% of participants) and essential fatty acids and omega-3 (24% of participants). Compared to non-CAM users, a greater proportion of CAM users were college-educated, had a higher household income, and lived in the West and Midwest regions of the U.S (all p < 0.01). In exploring trends, we found that overall CAM use increased by +203% (19% to 56%) between those diagnosed in 1996-1999 and 2010-2017. Between those diagnosed in 2005-2009 and 2010-2017, the largest changes in use were seen in acupuncture (+289%), Vitamin D (+204%), selenium (-59%), and vitamin E (-39%). Conclusions: PCa patients reported widespread CAM use in 1996-2017. Multivitamins were the most prevalent CAM, and use of acupuncture and Vitamin D increased dramatically. This information may help to prioritize research needs and reinforces the importance of discussing CAM use with patients, with referral to specialists (e.g., nutritionists) when indicated.

Background: Increasing evidence suggests that lifestyle factors may decrease the risk of prostate cancer progression. Lifestyle guidelines and tools may support lifestyle modification after diagnosis. Objective: To determine the feasibility and acceptability of a digital lifestyle intervention among men with prostate cancer. Design, setting, and participants: A 12-wk pilot randomized controlled trial among 76 men with clinical stage T1-T3a prostate cancer. Eligibility included Internet access, no contraindications to aerobic exercise, and engaging in four or fewer of eight targeted behaviors at baseline. Intervention: Website, Fitbit One, and text messaging to facilitate adoption of eight behaviors: vigorous activity, smoking cessation, and six diet improvements. Outcome measurements and statistical analysis: Our primary outcomes were feasibility and acceptability based on recruitment and user data, and surveys, respectively. Secondarily, we evaluated the change in eight lifestyle behaviors, and also objective physical activity. Each factor was assigned one point, for an overall "P8 score" (range 0-8). Analysis of covariance (ANCOVA) was conducted. Exploratory outcomes included quality of life, anthropometrics, and circulating biomarkers after 12 wk, and behaviors after 1 yr. Results and limitations: At baseline, men in both arms met a median of three targeted behaviors. Sixty-four men (n = 32 per arm) completed the study; 88% completed 12-wk assessments (intervention, 94%; control, 82%). Intervention participants wore their Fitbits a median of 82 d (interquartile range [IQR]: 72-83), replied to a median of 71% of text messages (IQR: 57-89%), and visited the website a median of 3 d (IQR: 2-5) over 12 wk. Median (IQR) absolute changes in the P8 score from baseline to 12 wk were 2 (1, 3) for the intervention and 0 (-1, 1) for the control arm. The estimated mean score of the intervention arm was 1.5 (95% confidence interval: 0.7, 2.3) higher than that of the control arm at 12 wk (ANCOVA p < 0.001). Changes were driven by diet rather than exercise. Limitations include self-reported diet and exercise data. Conclusions: Overall, in this novel pilot trial, the intervention was feasible and acceptable to men with prostate cancer. Next steps include improving the intervention to better meet individuals' needs and focusing on increasing physical activity in men not meeting nationally recommended physical activity levels. Patient summary: Tailored print materials combined with technology integration, including the use of a website, text messaging, and physical activity trackers, helped men with prostate cancer adopt healthy lifestyle habits, in particular recommended dietary changes, in the Prostate 8 pilot trial. (C) 2018 Published by Elsevier B.V. on behalf of European Association of Urology.

ObjectiveTo assess the association of genital numbness and erectile dysfunction in male cyclists.Subjects and methodsCyclists were recruited through Facebook advertisements and outreach to sporting clubs. This is a secondary analysis of a larger epidemiological population‐based study that examined sexual and urinary wellness in athletes. We queried cycling habits and erectile function using Sexual Health Inventory for Men (SHIM).ResultsA total of 2 774 male cyclists were included in the analysis. Amongst cyclists, there was a statistically significant increase in the trend of genital numbness presence with more years of cycling (P = 0.002), more frequent weekly cycling (P < 0.001), and longer cycling distance at each ride (P < 0.001). Less frequent use of padded shorts (odds ratio [OR] 0.14, P < 0.001) and lower handlebar (OR 0.49, P < 0.001) were associated with numbness, but body mass index (BMI) (OR 1.1, P = 0.33) and age (OR 1.2, P = 0.15) were not. In a multivariate logistic regression model, after adjusting for age, BMI, and lifetime miles (calculated by average daily cycling mileage × cycling days/week × cycling years.), there were no statistically significant differences in mean SHIM score between cyclists with and cyclists without numbness (20.3 vs 20.2, P = 0.83). However, interestingly, the subset of cyclists who reported numbness in the buttock reported statistically significantly worse SHIM scores (20.3 vs 18.4, P < 0.001). This association was not present in cyclists who reported numbness in the scrotum, penis, or perineum and remained significant after adjusting for overall biking intensity.ConclusionCyclists report genital numbness in proportion with biking intensity but numbness is not associated with worse sexual function in this cohort.

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII1 Apr 2018MP82-20 IMPROVING THE DETECTION OF HIGH-GRADE PROSTATE CANCER WITH MULTIPARAMETRIC MRI AND THE KALLIKREIN PANEL Adam Gadzinski, Hao Nguyen, Niloufar Ameli, Khaled Refaai, Katsuto Shinohara, Huiqing Wang, Benjamin Cedars, Zachary Kornberg, and Peter Carroll Adam GadzinskiAdam Gadzinski More articles by this author , Hao NguyenHao Nguyen More articles by this author , Niloufar AmeliNiloufar Ameli More articles by this author , Khaled RefaaiKhaled Refaai More articles by this author , Katsuto ShinoharaKatsuto Shinohara More articles by this author , Huiqing WangHuiqing Wang More articles by this author , Benjamin CedarsBenjamin Cedars More articles by this author , Zachary KornbergZachary Kornberg More articles by this author , and Peter CarrollPeter Carroll More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2748AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are limitations in the accuracy of PSA testing for early detection of clinically significant prostate cancer. We aim to assess the value of multiparametric MRI (mpMRI) and the kallikrein panel (4Kscore, OPKO Health, New Jersey, USA) both individually and in combination to predict high-grade prostate cancer (HG PCa) in men with PSA ≥3 ng/ml. METHODS We retrospectively reviewed 266 patients referred for biopsy with a PSA ≥3 ng/ml. Sixty-five men underwent 4Kscore analysis and mpMRI with template transrectal biopsy and concurrent mpMRI fusion biopsy for PI-RADS ≥3 lesions. We defined our main outcome of HG PCa as Gleason Score ≥3+4 on biopsy pathology. We compared the predictive capabilities of PSA to mpMRI PI-RADS, PSA density (PSAD) calculated from mpMRI prostate size, and 4Kscore using logistic regression models and the area under Receiver Operating Characteristic curve (AUC). RESULTS The median age was 67 (IQR 61-70), PSA 7.2 ng/ml (IQR 5.4-10.6), and 4Kscore 22% (IQR 10-34%). Forty-eight men (74%) had a PI-RADS ≥4 lesion and the median PSAD was 0.13 (IQR 0.10-0.22). HG PCa was detected in 27 of men (42%), whereas 14 (21%) had 3+3 and 24 (37%) had a negative biopsy. In the multivariate model adjusted for PSA, PSAD, mpMRI PI-RADS ≥4, and 4Kscore, both PSAD (OR: 3.41, 95% CI: 1.08-10.72, p=0.036) and PSA (OR: 0.22, 95% CI: 0.06-0.77, p=0.019) were statistically associated with HG PCa. The AUC for the PSA only model was 0.608 (95% CI: 0.465-0.751) (Figure). Adding PSAD, mpMRI PI-RADS, and 4Kscore to the model increased the discriminatory detection of HG PCa, with an AUC of 0.868 (95% CI: 0.780-0.957) (Figure). If only men with PI-RADS ≥4 or 4Kscore >7% were biopsied, then 14% of men would have been spared a biopsy and no HG PCa would have been missed. CONCLUSIONS In men with PSA ≥3 ng/ml, the addition of 4Kscore, PI-RADS, and PSAD improved the accuracy of detecting HG PCa. These findings may offer a more personalized approach to biopsy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1114 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Adam Gadzinski More articles by this author Hao Nguyen More articles by this author Niloufar Ameli More articles by this author Khaled Refaai More articles by this author Katsuto Shinohara More articles by this author Huiqing Wang More articles by this author Benjamin Cedars More articles by this author Zachary Kornberg More articles by this author Peter Carroll More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

70 Background: Multivitamin (MV) use is common among men with prostate cancer (PCa). Yet, data on MV use and risk of PCa recurrence are limited. Methods: We conducted a prospective study among 1,373 men with non-metastatic PCa to examine whether MV use after diagnosis was associated with risk of recurrence. Participants completed a comprehensive lifestyle survey a median of 2 y after diagnosis and were followed through 2016. We defined an event of recurrence as the first of the following: PCa death, bone metastasis from PCa, biochemical recurrence, or initiation of secondary treatment. Multivariate Cox Proportional Hazards regression models were used to calculate hazards ratios (HRs) and 95% confidence intervals (CI) for the association between MV use and PCa recurrence. We adjusted for time between diagnosis and the survey, age at diagnosis, Gleason grade, clinical T-stage, PSA at diagnosis, smoking, BMI, walking pace, and primary treatment. We also explored whether age at diagnosis, BMI, time since diagnosis, smoking, or clinical features (grade, stage, treatment) modified the association between MV use and recurrence. Results: We observed 142 events of PCa recurrence over a median follow-up of 10 y; 858 (62%) men were current MV users, 216 (16%) were past users, and 299 (22%) were never users. Overall, MV use was not associated with risk of PCa recurrence (current vs. never HR: 0.69; 95% CI: 0.45, 1.07; p-trend: 0.09). However, long-term MV users (≥10 y; n = 396) had a 56% lower risk of PCa recurrence compared to never users (HR: 0.44; 95% CI: 0.25, 0.78; p-trend: 0.006). Additionally, treatment modified the association between MV use and risk of PCa recurrence ( p-interaction: 0.02). Among the 845 men who had a radical prostatectomy (RP), current MV users had a 44% lower risk of PCa recurrence compared to past/never users (HR: 0.56; 95% CI: 0.34, 0.91; p-value: 0.02). MV use was not associated with risk of PCa recurrence among the 441 men who did not have a RP. Conclusions: Long-term MV use may be associated with lower risk of PCa recurrence.