Treatment for Localized Prostate Cancer: Long-Term Functional Outcomes

Regardless of choice of treatment, patients with clinically localized prostate cancer have a favorable long-term and cancer-specific rate of survival. Because there are no completed, long-term trials designed to compare survival outcomes with radical prostatectomy or external-beam radiation therapy, it is essential to predict functional outcomes as a component for decision-making regarding treatment, according to researchers.

Because the median life expectancy following treatment for prostate cancer is 13.8 years, an evaluation of long-term functional outcomes is vital to a clear understanding of the comprehensive experience of men living with a diagnosis of prostate cancer.

Researchers recently conducted an analysis to compare urinary, bowel, and sexual function and the extent to which men with clinically localized prostate cancer were bothered by declines in function 15 years after prostatectomy or radiotherapy. The researchers utilized data from the Prostate Cancer Outcomes Study (PCOS), a population-based cohort of men who were diagnosed with prostate cancer in the 1990s and followed up for 15 years after treatment. Results of the current analysis were reported in the New England Journal of Medicine [2013;368(5):436-444].

The PCOS enrolled 3533 men with incident prostate cancer from 5 Surveillance, Epidemiology, and End Results sites. Inclusion criteria for the current study were men with clinically localized prostate cancer who had been diagnosed between 55 and 74 years of age, who had completed either a 2-year or 5-year follow-up survey, and whose primary treatment was either prostatectomy or radiotherapy within 1 year of diagnosis. Of the original cohort, 1655 men met the additional criteria; of those, 70.3% (n=1164) had undergone prostatectomy and 29.7% (n=491) had undergone radiotherapy.

Functional status was evaluated at baseline and at 2, 5, and 15 years after diagnosis. The researchers compared functional outcomes according to treatment using multivariable propensity scoring.

Men in the prostatectomy group were significantly more likely to report urinary leakage compared with those in the radiotherapy group at both 2 years (odds ratio [OR], 6.22; 95% confidence interval [CI], 1.92-20.29) and 5 years (OR, 5.10; 95% CI, 2.29-11.36). There was no observed significant difference in the adjusted odds of urinary incontinence. However, patients in the prostatectomy group were more likely to wear incontinence pads at all study time points. There were no significant differences in the absolute likelihood and relative likelihood of being bothered by urinary incontinence 15 years after diagnosis.

Men who underwent prostatectomy were significantly more likely than those who underwent radiotherapy to report having erections insufficient for intercourse at 2 years (OR, 3.46; 95% CI, 1.93-6.17) and 5 years (OR, 1.96; 95% CI, 1.05-3.63). At 15 years, erectile dysfunction was nearly universal: 87.0% of men in the prostatectomy group and 93.9% of men in the radiotherapy group reported an inability to achieve an erection sufficient for intercourse.

Men in the prostatectomy group were less likely than those in the radiotherapy group to have bowel urgency at 2 years (OR, 0.39; 95% CI, 0.22-0.68) and at 5 years (OR, 0.47; 95% CI, 0.26-0.84). There was no significant difference between the groups in the odds of bowel urgency at 15 years.

In conclusion, the researchers said, “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.”