Prostate cancer is the most frequent male cancer disease in the western world. Sexual dysfunction is common after prostate cancer with radiation therapy and androgen deprivation therapy, but further research is needed to determine the lived experience of couples struggling with sexual dysfunction after treatment. The purpose of this study was to explore the lived experience of men and their partners experiencing sexual side effects after radiation therapy and androgen deprivation therapy for prostate cancer. In addition, to understand the role of a structured rehabilitation program on the couple's experience. Couples with persistent sexual problems were recruited among patients treated with radiotherapy or/and androgen deprivation therapy. Descriptive statistics were collected including age, race, education and work. Focus groups with each gender were conducted using open ended questions to encourage participants to talk about their experiences. Data were analyzed using Giorgi's phenomenological method. A total of eight couples were recruited, men age 67 years [standard deviation (SD) 6·3], women 65 years (SD 7·2). Results from the focus group interviews regarding marital relations were grouped in three themes: negative impact of sexual dysfunction on the relationship; other physical and psychological consequences of late adverse effects; communication issues and partner feelings of frustration. Results regarding the rehabilitation program were grouped in four themes: importance of peer support; importance of time and space for reflection; improved communication; optimism after rehabilitation. The couples in this study reported that the sexual side effects of prostate cancer treatment impacted their relationship and were problematic for both the men and their partners. The rehabilitation program improved the couples communication concerning sexual intimacy and issues related to prostate cancer treatment. It also offered a chance for peer support from others going through similar experiences and increased hope for navigating through sexual and intimacy issues in the future.

Pre-operative urinary prostate cancer antigen 3 (PCA3) gene scores predict for adverse pathologic features (APF) at radical prostatectomy (RP) in men with low-and intermediate-risk prostate cancer (PCa). However, whether these predict for APF in men with higherrisk disease, or for progression-free survival (PFS) in general, is unknown. We retrospectively investigated whether PCA3 scores were predictive for APF or PFS in men with higher-risk PCa. Materials/Methods: One hundred nine men with cT1-T2 National Comprehensive Care Network (NCCN) intermediate-and high-risk PCa were treated with RP from 2010-2015. Logistic regression analysis was performed to evaluate the association of PCA3 score with selected APFsdseminal vesicle invasion [SVI], lymph node positivity (pLN+), upgrading to Gleason score (pGS) 8-10 or tertiary pattern 5, and upstaging to pT3 diseasedafter adjusting for age, initial PSA (iPSA), clinical Tstage, biopsy GS, percent positive biopsies (PPB), and MRI T-stage. Biochemical recurrence was defined as confirmatory PSA 0.2 ng/mL or initiation of salvage therapy. Among 78 men with 1 year follow-up, the association between PCA3 score and PFS was assessed using Cox regression analysis after adjusting for age, pre-operative risk group, maximal tumor diameter (MTD), pGS, extracapsular extension (ECE), SVI, and pLN+. Kaplan-Meier analysis was performed to estimate 3-year PFS. Results: Median follow-up was 2.3 years. Forty-eight percent had intermediate-risk and 52% had high-risk PCa. At RP, 42% had ECE, 10% had SVI, and 10% had pLN+. Twenty-one percent experienced GS upgrading and 41% were upstaged to pT3. On multivariate analysis (MVA), multiple significant predictors for individual APFs were elucidated, including increasing bGS predicting for SVI (OR 6.80, pZ0.040), increasing iPSA and PPB predicting for pLN+ (ORs 1.12 and 1.06; p<0.05 for both), and increasing bGS, iPSA, and PPB predicting for upstaging to pT3 (ORs of 3.64, 1.08, and 1.03; p<0.05 for all). Overall, 3-year PFS was 70%. No significant predictors for PFS were found on MVA, but NCCN risk group (hazard ratio [HR] 4.17), MTD (HR 1.83), ECE (HR 2.69), SVI (HR 3.04), pLN+ (HR 3.70), and pGS (HR 4.79) were all significant on univariate analysis (UVA, p<0.05 for all). PCA3 score was not associated with any APF or with PFS on UVA or MVA. Conclusion: Unlike in lower-risk cohorts, PCA3 score was not associated with any APF in this higher-risk cohort, despite enrichment for APFs. Similarly, despite a relatively high number of biochemical recurrences, PCA3 score was not associated with PFS. Notably, multiple known preoperative predictors for APFs were significant on MVA, and multiple predictors were associated with PFS on UVA. These results suggest that PCA3 may not be a useful adjunct predictive marker in men with higherrisk PCa.

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