Are functional outcomes different for men with localized prostate cancer depending on treatment choice?

In men with localized prostate cancer, most functional outcome differences related to treatment options attenuated by 5 years. However, men who underwent prostatectomy reported worse urinary incontinence and sexual function through 5 years than men who chose other treatment options. Survival rates within the 2 groups of favorable-risk and unfavorable-risk prostate cancer did not differ based on treatment option. (LOE = 2b)

Hoffman KE, Penson DF, Zhao Z, et al. Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer. JAMA 2020;323(2):149-163.  [PMID:31935027]

Cohort (prospective)

Government

Population-based

These investigators analyzed data from a prospective cohort study of 2005 men with localized prostate cancer. Using standard diagnostic criteria, participants were further classified as having either favorable-risk (n = 1386) or unfavorable-risk (n = 619) cancer. Treatment, including active surveillance, nerve-sparing prostatectomy, external beam radiation therapy (EBRT) with or without androgen deprivation therapy (ADT), or low-dose-rate brachytherapy (LDRB), was determined by patient report at 1 year. Patient-reported outcomes, using previously validated assessment tools, had a 77% response rate at 5 years. Survival outcomes occurred through review of appropriate medical records and cancer surveillance registries. In men with favorable-risk prostate cancer, prostatectomy was associated with worse urinary incontinence at 5 years and sexual function at 3 years compared with active surveillance. LDRB was associated with worse urinary irritative function, sexual function, and bowel function at 1 year compared with active surveillance, but functional differences no longer remained after 5 years. In men with unfavorable-risk disease, EBRT with ADT was associated with lower bowel function at 1 year but better sexual function at 5 years and less urinary incontinence through 5 years than prostatectomy. Survival rates within each risk group were similar regardless of treatment option.