Adverse Outcomes Following Curative Treatment for Prostate Cancer

Patients with clinically localized prostate cancer are typically offered an array of treatment options that may include active surveillance; radical prostatectomy; and radiotherapy, with or without androgen-deprivation therapy (ADT). No prospective data on disease outcomes provide support for either surgery or radiotherapy, therefore many patients make treatment decisions based on their understanding of the potential impact on urinary, sexual, or bowel function.

Investigators evaluated treatment-related functional outcomes in an observational study of 2445 patients treated for localized prostate cancer who were enrolled in the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study. Patients were divided into two groups at the time of diagnosis: favorable prognosis (cT1 or T2a/bN0M0, prostate specific antigen [PSA] ≤20 ng/mL, and grade group 1–2) and unfavorable prognosis (cT2cN0M0, PSA 20–50 ng/mL, or grade group 3–5). The primary outcomes were 10-year patient reported sexual, urinary incontinence, urinary irritation, bowel, and hormone function domain scores, measured with the validated Prostate Cancer Index Composite (EPIC-26).

Patients' median age was 64 years; 14% were African American, 8% Hispanic. Patients in the favorable-prognosis group underwent radical prostatectomy (1088 patients), radiotherapy (380), active surveillance (414), and low-dose brachytherapy (96). Patients in the unfavorable-prognosis group underwent radical prostatectomy (387) and radiotherapy (220).

Among patients with favorable prognosis, those undergoing radical prostatectomy had worse urinary incontinence but no major difference in sexual function compared with patients followed with active surveillance. Among patients with unfavorable prognosis, those treated with radical prostatectomy had worse urinary incontinence but no major difference in sexual function compared with those treated with radiotherapy plus ADT; patients managed with radiotherapy plus ADT experienced worse bowel and hormone function than those treated with radical prostatectomy.