Long-Term Functional Outcomes after Treatment for Localized Prostate Cancer

Abstract

Background The purpose of this analysis was to compare long-term urinary, bowel, and sexual function after radical prostatectomy or external-beam radiation therapy. Methods The Prostate Cancer Outcomes Study (PCOS) enrolled 3533 men in whom prostate cancer had been diagnosed in 1994 or 1995. The current cohort comprised 1655 men in whom localized prostate cancer had been diagnosed between the ages of 55 and 74 years and who had undergone either surgery (1164 men) or radiotherapy (491 men). Functional status was assessed at baseline and at 2, 5, and 15 years after diagnosis. We used multivariable propensity scoring to compare functional outcomes according to treatment. Results Patients undergoing prostatectomy were more likely to have urinary incontinence than were those undergoing radiotherapy at 2 years (odds ratio, 6.22; 95% confidence interval [CI], 1.92 to 20.29) and 5 years (odds ratio, 5.10; 95% CI, 2.29 to 11.36). However, no significant between-group difference in the odds of urinary incontinence was noted at 15 years. Similarly, although patients undergoing prostatectomy were more likely to have erectile dysfunction at 2 years (odds ratio, 3.46; 95% CI, 1.93 to 6.17) and 5 years (odds ratio, 1.96; 95% CI, 1.05 to 3.63), no significant between-group difference was noted at 15 years. Patients undergoing prostatectomy were less likely to have bowel urgency at 2 years (odds ratio, 0.39; 95% CI, 0.22 to 0.68) and 5 years (odds ratio, 0.47; 95% CI, 0.26 to 0.84), again with no significant between-group difference in the odds of bowel urgency at 15 years. Conclusions At 15 years, no significant relative differences in disease-specific functional outcomes were observed among men undergoing prostatectomy or radiotherapy. Nonetheless, men treated for localized prostate cancer commonly had declines in all functional domains during 15 years of follow-up. (Funded by the National Cancer Institute.)

Long-term Health-related Quality of Life After Primary Treatment for Localized Prostate Cancer: Results from the CaPSURE Registry

“…The recent Prostate Cancer Outcomes Study (PCOS) reported that surgery had the most profound impact on sexual HRQOL [6]. Although we noticed a similar pattern, these differences appeared smaller in magnitude.…”

“…After adjustment for factors such as age, comorbidity, and baseline function, we found that men who underwent NSRP were less likely to experience a decline in sexual function compared to their nonNSRP counterparts. Both our study and PCOS [6] report worse declines in urinary function after surgery. However, both studies measured urinary function using the UCLA PCI, which focuses primarily on urinary incontinence rather than irritating or obstructive symptoms, and, therefore, reflects the impact of surgery on urinary function to a greater extent than that of radiation or local tumor progression.…”

“…Although other studies reported similar findings at short to intermediate follow-up [5], we found this deficit in bowel function after radiotherapy persisted for the long term and increased in magnitude over time. This differs from PCOS, where differences in bowel function attenuated over time [6]. These findings require further validation.…”

“…Surgery generally has the largest impact on erectile function and urinary continence, while radiation has the largest impact on bowel and urinary irritation. Although studies provide consistent short-to intermediate-term results, few have reported follow-up beyond 5 yr. A 2013 population-based study reported that declines in HRQOL persist 10-15 yr after treatment, although differences between treatments attenuate over time [6]. However, this study focused only on radiotherapy and surgical patients.…”

Who Bears the Greatest Burden of Aggressive Treatment of Indolent Prostate Cancer?

“…[20][21][22] However, in the case of indolent prostate cancer, our results demonstrate that these factors are associated with high rates of potentially detrimental aggressive treatment. Specifically, given that patients with indolent prostate cancer are unlikely to die of the disease, those who are treated aggressively may unnecessarily experience the morbidities associated with surgery or radiation, 23 with little to no benefit from treatment. [7][8][9] Men of high socioeconomic status and Caucasian men with prostate cancer have greater access to healthcare and health insurance coverage compared with men of low socioeconomic status and minority men, 24,25 which may be the underlying driver of high rates of aggressive therapy for their indolent prostate cancer.…”