Prostate cancer study tracks long-term urinary, sexual and bowel function side effects
Long-term functional outcomes after radical prostatectomy or external-beam radiation therapy for localised prostate cancer
- Date : 01 Feb 2013
- Topic : Genitourinary cancers
A new study comparing outcomes among prostate cancer patients treated with surgery versus radiotherapy found differences in urinary, bowel and sexual function after short-term follow-up, but those differences were no longer significant 15 years after initial treatment. The study, led by first author Dr Matthew Resnick, instructor in urologic surgery at Vanderbilt University Medical Center, was published in the January 31 issue of the New England Journal of Medicine.
The Prostate Cancer Outcomes Study (PCOS) enrolled 3,533 men in whom prostate cancer had been diagnosed in 1994 or 1995. The current cohort comprised 1,655 men in whom localised prostate cancer had been diagnosed between the ages of 55 and 74 years and who had undergone either surgery (1,164 men – 70,3%) or radiotherapy (491 men – 29,7%). Functional status was assessed at baseline and at 2, 5, and 15 years after diagnosis. The investigators used multivariable propensity scoring to compare functional outcomes according to treatment. At the time of enrollment, the patients were asked to complete a survey about clinical and demographic issues and health-related quality of life. The men were contacted again at set times following treatment and were asked about clinical outcomes and disease-specific quality of life issues.
A study of 15-year outcomes represents a mature portrait of quality of life issues following prostate cancer treatment
Men whose prostates had been surgically removed were significantly more likely than those who received radiation therapy to report urinary incontinence at two years and five years. However, at 15 years, the investigators found no significant difference in the adjusted odds of urinary incontinence. Nonetheless, patients in the surgery group were more likely to wear incontinence pads throughout the 15-year follow-up period.
Men in the prostatectomy group were also significantly more likely than those in the radiotherapy group to report having problems with erectile dysfunction two years and five years after surgery. Despite early and intermediate-term data revealing treatment-dependent differences in patterns of sexual dysfunction, after five years both groups had a gradual decline in sexual function. At 15 years, erectile dysfunction was nearly universal with 87% in the prostatectomy group and 93.9% in the radiotherapy group reporting sexual difficulties. The authors noted that age may have played a role in the patients' waning sexual function, as shown in unrelated studies.
Some patients also experienced problems with bowel function in the years following treatment. Those who were treated with radiotherapy had more problems in the short term. Men in the radiotherapy group reported significantly higher rates of bowel urgency than those in the prostatectomy group at two years and five years. However, at 15 years, despite absolute differences in the prevalence of bowel urgency between the two groups, the researchers found no significant difference in the odds of bowel urgency. Men who had been treated with radiotherapy were significantly more likely to report being bothered by bowel symptoms at both the two-year and 15-year points.
The authors concluded that at 15 years, no significant relative differences in disease-specific functional outcomes were observed among men undergoing prostatectomy or radiotherapy. Nonetheless, men treated for localised prostate cancer commonly had declines in all functional domains during 15 years of follow-up.
Regardless of the form of initial treatment, patients in this study had significant declines in sexual and urinary function over the duration of the study. Since the median life expectancy after treatment for prostate cancer is 13.8 years, the authors suggested that these data may be used by physicians to counsel men who are considering treatment for localised disease.
Funding for the research was supported by a grant from the USA National Cancer Institute – a division of the National Institutes of Health (R01-CA114524), and contracts from each of the participating institutions (N01-PC-67007, N01-PC-67009, N01-PC-67010, N01-PC-67006, N01-PC-67005, and N01-PC-67000). Dr Resnick was supported by the Veterans Affairs National Quality Scholars Program (with use of facilities at Veterans Health Administration Tennessee Valley Healthcare System) and the T.J. Martell Foundation.
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