{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T22:43:07Z","timestamp":1793659387109,"version":"4.5.1"},"reference-count":42,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To prospectively evaluate functional patient\u2010reported outcomes (PROs) in patients with low\u2010risk prostate cancer (PCa) managed with active surveillance (AS), nerve\u2010sparing radical prostatectomy (NS\u2010RP), non\u2010NS\u2010RP, or radiotherapy (RT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>This multicentre prospective cohort study used data from the Prostate Cancer Outcomes (PCO) study in Germany, Austria and Switzerland, including 6265 patients with low\u2010risk PCa enrolled between 2016 and 2023. PROs were assessed at baseline and 12\u2009months after treatment\/enrolment using the 26\u2010item Expanded Prostate Cancer Index Composite Short Form (EPIC\u201026), measuring urinary continence, bowel, sexual, hormonal, and irritative\/obstructive symptoms. Mean score changes were compared with minimal important differences (MIDs) to determine clinical significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In all, 475, 4352, 813, and 625 patients received AS, NS\u2010RP, non\u2010NS\u2010RP, and RT, respectively. At 12\u2009months, AS was associated with stable function across all EPIC\u201026 domains. In contrast, both RP groups experienced significant declines in urinary continence (NS\u2010RP: \u221218\u2009points; non\u2010NS\u2010RP: \u221226\u2009points) and sexual function (NS\u2010RP: \u221235\u2009points; non\u2010NS\u2010RP: \u221230\u2009points), exceeding MID thresholds. Urinary continence did not decline after RT but clinically relevant declines occurred in irritative\/obstructive urinary (\u22125\u2009points), bowel (\u22127\u2009points), hormonal (\u22125\u2009points), and sexual function (\u221212\u2009points). Age\u2010stratified analysis showed clinically significant declines in urinary and sexual function after NS\u2010RP across all age groups, with the greatest loss in sexual function among younger patients and the most pronounced continence impairment in the 70\u201379\u2009years age group. In contrast, functional outcomes under AS remained stable in all age cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Active surveillance is underutilised in the observed cohort. Prospective PCO data demonstrates that AS preserves urinary continence and sexual function compared to active treatment, supporting its role as the first\u2010line strategy for suitable candidates. Despite advancements including NS techniques, RP, and to a lesser extent RT, remain associated with substantial functional impairment even in younger men.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70167","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T02:01:43Z","timestamp":1771293703000},"page":"716-727","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Patient\u2010reported outcomes: active surveillance vs radical therapies in low\u2010risk prostate cancer"],"prefix":"10.1111","volume":"137","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7213-9417","authenticated-orcid":false,"given":"Mulham","family":"Al\u2010Nader","sequence":"first","affiliation":[{"name":"Department of Urology University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Kesch","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris A.","family":"Hadaschik","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Fichtner","sequence":"additional","affiliation":[{"name":"Department of Urology Johanniter Hospital  Oberhausen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guenther","family":"Carl","sequence":"additional","affiliation":[{"name":"Bundesverband Prostatakrebs Selbsthilfe e.V.  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