Acute, Subchronic, and Chronic Complications of Radical Prostatectomy Versus Radiotherapy With Hormone Therapy in Older Adults With High-Risk Prostate Adenocarcinoma

Abstract

PurposeTo compare acute, subchronic, and chronic complications between older patients with high-risk localized prostate cancer (HR-LPC) receiving radical prostatectomy (RP) and high-dose intensity-modulated radiotherapy (IMRT) combined with long-term hormone therapy (HT).Patients and MethodsWe recruited older patients (≥80 years) with HR-LPC from the Taiwan Cancer Registry database. After propensity score matching, logistic regression analysis was used to compare the acute, subchronic, and chronic complication rates between patients who underwent RP (the RP group) and high-dose IMRT combined with long-term HT (the IMRT+HT group).ResultsBenign prostatic hyperplasia (BPH) symptoms and urinary incontinence (UI) were the most common complications over 5 years (BPH symptoms: RP, 17.69%; IMRT+HT, 29.58%; UI: RP, 10.47%; IMRT+HT, 5.50%). Compared with the RP group, the IMRT+HT group had higher odds of BPH symptoms and lower odds of UI and hernia after the 5-year follow-up period. The impotence rates were significantly higher in the IMRT+HT group than in the RP group at 3 months and 1 year after treatment and became nonsignificant after 2 years. At 5 years after treatment, the IMRT+HT group had lower risks of UI (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.28–0.88) and hernia (aOR, 0.21; 95% CI, 0.11–0.82) and a higher risk of BPH symptoms (aOR, 4.15; 95% CI, 2.82–7.37) than the RP group.ConclusionIMRT+HT was associated with lower UI and hernia risks than RP. By contrast, RP was associated with fewer complications of BPH over the follow-up period and less impotence during the first year after treatment. Our findings provide important and valuable references for shared decision-making for optimal therapy selection among older men with HR-LPC.

Surgical Tolerability and Frailty in Elderly Patients Undergoing Robot-Assisted Radical Prostatectomy: A Narrative Review

“…In general, patients who undergo RP are more likely to suffer complications involving urinary incontinence (UI) and erectile dysfunction (ED) when compared with other treatment modalities such as RT with or without ADT [ 41 , 42 ]. However, a recent propensity-score-matched study comparing complication status between RP and high-dose intensity-modulated radiotherapy (IMRT) combined with long-term hormone therapy (HT) showed otherwise with respect to erectile dysfunction in patients with age ≥80 years [ 43 ]. This retrospective cohort included 659 patients with high-risk PCa and was conducted by propensity score matching of a 1:2 ratio based on positive surgical margin status (277 patients for RP and 382 patients for IMRT + HT) and compared acute and chronic complications after treatments [ 43 ].…”

“…However, a recent propensity-score-matched study comparing complication status between RP and high-dose intensity-modulated radiotherapy (IMRT) combined with long-term hormone therapy (HT) showed otherwise with respect to erectile dysfunction in patients with age ≥80 years [ 43 ]. This retrospective cohort included 659 patients with high-risk PCa and was conducted by propensity score matching of a 1:2 ratio based on positive surgical margin status (277 patients for RP and 382 patients for IMRT + HT) and compared acute and chronic complications after treatments [ 43 ]. The approach of RP was not shown, and therefore the number of cases performed in robotic procedures is unknown.…”

“…In addition, patients in the IMRT + HT group received 1.5–3 years of long-term HT in combination with IMRT. The rates of erectile dysfunction were significantly higher in the IMRT + HT group at 3 months and 1 year after treatment [ 43 ]. Benign prostatic hyperplasia (BPH) symptoms were more frequently observed in the IMRT+HT group at any time points throughout the study (days 1–90, days 91–365, 2 years, 3 years, 4 years, and 5 years after treatment) [ 43 ].…”

“…The rates of erectile dysfunction were significantly higher in the IMRT + HT group at 3 months and 1 year after treatment [ 43 ]. Benign prostatic hyperplasia (BPH) symptoms were more frequently observed in the IMRT+HT group at any time points throughout the study (days 1–90, days 91–365, 2 years, 3 years, 4 years, and 5 years after treatment) [ 43 ]. On the contrary, UI was more frequently observed in the RP group throughout all time points.…”

“…On the contrary, UI was more frequently observed in the RP group throughout all time points. After 5 years, common chronic complications were BPH symptoms and UI (RP vs. IMRT+HT: 17.7% vs. 29.6% and 10.5% vs. 5.5%, respectively) [ 43 ]. Notably, the occurrence rate of hernia was also higher in the RP group, although the type of hernia was not mentioned.…”