RP, radiation outcomes similar after 15 years

A new multicenter 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.

For the study, which was published in the New England Journal of Medicine (2013; 368:436-45), the authors followed 1,655 men between the ages of 55 and 74 years from the Prostate Cancer Outcomes Study, of whom 1,164 (70.3%) had undergone prostatectomy and 491 (29.7%) had undergone radiotherapy. 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 intervals following treatment and were asked about clinical outcomes and disease-specific quality of life issues.

Men who underwent radical prostatectomy were significantly more likely than those who received radiation therapy to report urinary leakage at 2 years and 5 years. However, at 15 years, the authors 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 2 years and 5 years after surgery.

"This study of 15-year outcomes represents a mature portrait of quality of life issues following prostate cancer treatment," said senior author David Penson, MD, MPH, of Vanderbilt University Medical Center, Nashville, TN. "Patients need to be aware that all aggressive therapies for prostate cancer have significant side effects and perhaps these data make an argument for active surveillance in certain cases."

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