UI most problematic with RP
Men undergoing RP had a significant decline in score on the urinary incontinence domain at 3 years compared with the AS group (–13.4 points; p<.001) and the EBRT group (–18 points; p<.001). Differences of at least six points were considered clinically important. On multivariable analysis, RP and baseline function were the dominant predictors of functional outcome. About 14% of men who underwent RP reported urinary incontinence as at least a moderate problem compared with 5% of men who chose EBRT and 6% who chose AS (p<.001).
Urinary irritative symptoms improved with RP compared with AS. On multivariable analysis controlling for baseline function, RP had a larger negative impact than EBRT on sexual function domain scores (–17.1 points; p<.001).
“Baseline score also has a big impact on your post-treatment function,” said Dr. Barocas. The difference between RP and EBRT was only significant among men with baseline function scores in the highest quartile. About 40% of men had erections insufficient for intercourse before treatment, he noted.
“The bottom line is that sexual function outcomes are not clinically relevant for all men,” he said.
Bowel function scores decreased by a clinically significant amount (≥5 points) among men who chose EBRT versus AS, “but that difference is significant only up to about 1 year,” he said. “The same is true for the hormone therapy [domain] score.”
General quality of life was the same across treatments, as was disease-specific survival. Overall survival was higher for RP (99%) compared with EBRT (96%) and AS (97%), but this difference was significant only on unadjusted analysis (p<.001).
“There weren’t enough deaths to do a multivariable analysis, and the difference in survival is undoubtedly attributable to differences between groups in baseline characteristics,” Dr. Barocas said.
“Disease management should be individualized,” he concluded. “We hope that our information provides a basis for shared decision-making.”
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