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Surgery, radiation treatment associated with similar long-term adverse effects
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Men treated for localized prostate cancer exhibited similar levels of urinary incontinence, erectile dysfunction and bowel urgency 15 years after treatment, regardless of whether they underwent surgery or radiation therapy.
Previous studies — using short-term follow-up (1 to 3 years) and intermediate-term follow-up (4 to 5 years) — have reported some notable differences in functional outcomes between patients who undergo prostatectomy vs. those who undergo radiotherapy. However, no studies have investigated longer-term outcomes.
Matthew J. Resnick
“Since the median life expectancy after treatment for prostate cancer is 13.8 years, a careful evaluation of long-term functional outcomes is critical to an understanding of the comprehensive experience of men living with a diagnosis of prostate cancer,” Matthew J. Resnick, MD, in the department of urologic surgery at Vanderbilt University Medical Center, and colleagues wrote.
Resnick and colleagues used data from the Prostate Cancer Outcomes Study — a population-based cohort of patients whose prostate cancer had been diagnosed in the mid-1990s and who had been followed prospectively for 15 years — to compare urinary, bowel and sexual function and the extent to which men were affected by declines in function 15 years after prostatectomy or radiotherapy for localized prostate cancer,
The study cohort included 1,655 patients in whom localized prostate cancer had been diagnosed from aged 55 to 74 years. Of them, 1,164 patients had undergone surgery and 491 had undergone radiotherapy.
Researchers assessed functional status at baseline and again at 2, 5 and 15 years after diagnosis. They used multivariable propensity scoring to compare functional outcomes according to treatment.
Patients who underwent prostatectomy were more likely to experience urinary incontinence than those who received radiotherapy at 2 years (OR=6.22; 95% CI, 1.92-20.29) and 5 years (OR=5.10; 95% CI, 2.29-11.36), according to study results.
However, the researchers found no significant difference in the odds of urinary incontinence at 15 years. Likewise, although patients who underwent prostatectomy were more likely to exhibit erectile dysfunction at 2 years (OR=3.46; 95% CI, 1.93-6.17) and 5 years (OR=1.96; 95% CI, 1.05-3.63), no significant difference was observed at 15 years.
“Whereas short- and intermediate-term data reveal differences in functional profiles among men undergoing prostatectomy and radiotherapy, at 15 years we observed no significant relative between-group differences,” Resnick and colleagues wrote. “Considering the often long duration of survival after treatment for prostate cancer, these data may be used to counsel men considering treatment for localized disease.”
Perspective
Back to TopKevin L. Stephans, MD
This study represents a valuable contribution in providing the first large-scale comparison of long-term quality of life between patients treated with radical prostatectomy compared with external beam radiation (EBRT) for prostate cancer. This study echoes previous intermediate-term outcomes in demonstrating EBRT to be associated with an increased risk of bowel complications, fleeting advantage in preservation of sexual function and reduced rates of urinary incontinence — particularly in patients with excellent baseline urinary function — compared with radical prostatectomy.
The study understandably loses statistical power over time, particularly given the older demographic of the EBRT patients, perhaps explaining the loss of a statistically significant difference in the urinary domain at 15 years. The curves provided in Figures 1 to 3 remain visibly separated, despite some late increase in urinary symptoms for radiated patients, consistent with available retrospective data. Limitations of the study include baseline differences inherent to non-randomized patient populations, as well as the lack of a brachytherapy cohort. The outstanding efforts of the investigators are to be commended for providing such complete long-term data.
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