Key points Among patients treated for localized prostate cancer, what are the associations between specific treatments and functional outcomes such as urinary incontinence and sexual dysfunction? Findings In this observational study of 2,445 people treated for localized prostate cancer and followed for 10 years, compared with radiotherapy or surveillance, radical prostatectomy was associated with worse urinary incontinence but not worse sexual function among 1,877 patients with a favorable prognosis. start of the study. Compared with radiotherapy with androgen deprivation therapy, radical prostatectomy was associated with worse urinary incontinence but not worse sexual function among the 568 patients with poor prognosis. Meaning In localized prostate cancer, radical prostatectomy was associated with worse urinary incontinence, but not worse sexual function, over 10 years of follow-up. |
Importance
Adverse outcomes associated with treatments for localized prostate cancer remain unclear.
Aim
To compare rates of adverse functional outcomes between specific treatments for localized prostate cancer.
Design, environment and participants
An observational cohort study using data from five US Surveillance, Epidemiology, and End Results Program registries. Participants were treated for localized prostate cancer between 2011 and 2012.
At baseline, 1877 had favorable prognosis prostate cancer (defined as cT1-cT2bN0M0, prostate-specific antigen level <20 ng/ml, and grade group 1-2) and 568 had poor prognosis localized prostate cancer (defined such as cT2cN0M0, prostate-specific antigen level of 20 to 50 ng/ml or grade group 3 to 5). Follow-up data were collected by questionnaire until February 1, 2022.
Exhibitions
Radical prostatectomy (n = 1043), external beam radiation therapy (n = 359), brachytherapy (n = 96), or active surveillance (n = 379) for favorable prognosis disease and radical prostatectomy (n = 362) or external beam radiation therapy with androgen deprivation therapy (n = 206) for a disease with an unfavorable prognosis.
Main results and measures
Outcomes were patient-reported sexual, urinary, bowel, and hormonal function , measured using the 26-item Expanded Prostate Cancer Composite Index (range, 0-100; 100 = best).
Associations of specific therapies with each outcome were estimated and compared 10 years after treatment, adjusting for corresponding baseline scores and patient and tumor characteristics.
The minimal clinically important differences were 10 to 12 for sexual function, 6 to 9 for urinary incontinence, 5 to 7 for urinary irritation, and 4 to 6 for bowel and hormonal function.
Results
A total of 2,445 patients with localized prostate cancer (mean age, 64 years; 14% black, 8% Hispanic) were included and followed for a mean of 9.5 years.
Among 1,877 patients with a favorable prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference, -12.1 [95% CI, -16.2 to -8.0]), but not with worse sexual function (adjusted mean difference, −7.2 [95% CI, −12.3 to −2.0]), compared with active surveillance.
Among 568 patients with poor prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference, −26.6 [95% CI, −35.0 to −18.2]), but not worse sexual function (adjusted mean difference, −1.4 [95% CI, −11.1 to 8.3), compared with external beam radiation therapy with androgen deprivation therapy.
Among patients with poor prognosis , external beam radiation therapy with androgen deprivation therapy was associated with worse bowel outcomes (adjusted mean difference, −4.9 [95% CI, −9.2 to −0.7 ]) and hormonal function (adjusted mean difference, −4.9 [95% CI], −9.5 to −0.3]) compared with radical prostatectomy.
Conclusions and relevance Among patients treated for localized prostate cancer, radical prostatectomy was associated with worse urinary incontinence but not worse sexual function at 10 years of follow-up compared with radiation therapy or surveillance among those with a more favorable prognosis and compared to radiotherapy for those with an unfavorable prognosis. Among men with poor-prognosis disease, external beam radiation therapy with androgen deprivation therapy was associated with worse bowel and hormonal function at 10-year follow-up compared with radical prostatectomy. |
