Long term functional outcomes similar with surgery, radiotherapy in prostate cancer patients

Jan 31st – NEJM – While 15-year outcomes are similar, at years 2 and 5 years radiotherapy is superior to prostatectomy in urinary and erectile functions.

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Image: CC/Nephron. Gleason 4 prostatic acinar adenocarcinoma.

1. At 2 years and 5 years from diagnosis, radiotherapy is superior to prostatectomy in such functional outcomes as urinary and erectile functions while inferior in bowel functions.

2. At 15 years, both the radiotherapy and prostatectomy cohorts showed functional outcomes that were not significantly different, amid generalized declines in all measures.

Preservation of quality of life is a major consideration in selecting treatment plans for prostate cancer patients. As one patient might prioritize preserving sexual function and another might prefer to avoid bowel urgency, physicians must incorporate patients’ preferences regarding quality of life into clinical decision-making.

This study compared radiotherapy and prostatectomy in three domains of functional outcomes- urinary, sexual and bowel. Outcomes were mixed at 2-year and 5-year intervals– the radiotherapy cohort had better functional outcomes in urinary and erectile function but worse outcomes in bowel function than the prostatectomy cohort. At 15 years, discrepancies disappeared and both cohorts experienced functional declines in all three domains.

These results affirm that physicians must prepare patients to expect long-term functional decline regardless of the treatment chosen. One caveat to this result is that the study may have been underpowered as many patients either died or were lost to follow-up by the 15-year point. A larger study might overcome this limitation and provide more accurate long-term comparisons.

Click to read the study in NEJM

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Image: CC/Nephron. Gleason 4 prostatic acinar adenocarcinoma.

1. At 2 years and 5 years from diagnosis, radiotherapy is superior to prostatectomy in such functional outcomes as urinary and erectile functions while inferior in bowel functions.

2. At 15 years, both the radiotherapy and prostatectomy cohorts showed functional outcomes that are not significantly different, amid generalized declines in all measures.

This [prospective cohort ] study followed a subset of patients enrolled in the Prostate Cancer Outcomes Study (PCOS) over 15 years. Patients were divided into cohorts based on if they received radiotherapy or prostatectomy. Functional outcomes were evaluated at 2, 5, and 15-year intervals from diagnosis based on patient-reported scores in 3 domains – urinary, erectile and bowel functions. Though patients undergoing prostatectomy were more likely to have urinary incontinence at 2 (odds ratio (OR) = 6.22; confidence interval (CI) = 1.92 to 20.29) and 5 years (OR = 5.10; 95% CI, 2.29 to 11.36), these differences disappeared by year 15. Erectile function followed a similar trend while bowel urgency was improved for the first 5 years in prostatectomy patients, though again no differences existed at 15 years.

Further reading:

1. Transurethral prostatectomy: immediate and postoperative complications. a cooperative studyof 13 participating institutions evaluating 3,885 patients

2. Predictors of patient preferences and treatment choices for localized prostate cancer

In sum: Preservation of quality of life is a major consideration in selecting treatment plans for prostate cancer patients. As one patient might prioritize preserving sexual function and another might prefer to avoid bowel urgency, physicians must incorporate patients’ preferences regarding quality of life into clinical decision-making.

This study compared radiotherapy and prostatectomy in three domains of functional outcomes- urinary, sexual and bowel. Outcomes were mixed at 2-year and 5-year intervals– the radiotherapy cohort had better functional outcomes in urinary and erectile function but worse outcomes in bowel function when compared to the prostatectomy cohort. At 15 years, discrepancies disappeared and both cohorts experienced functional declines in all three domains.

These results affirm that physicians must prepare patients to expect long-term functional decline regardless of the treatment chosen. One caveat to this result is that the study may have been underpowered as many patients either died or were lost to follow-up by the 15-year point. A larger study might overcome this limitation and provide more accurate long-term comparisons.

Click to read the study in NEJM

By Xiaozhou Liu and Mitalee Patil

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