Functional outcomes among men undergoing prostatectomy or radiotherapy for prostate cancer differed at two and five years of follow-up, but significant differences were no longer present by 15 years, a study found.
To compare long-term urinary, bowel and sexual function after radical prostatectomy or external-beam radiation therapy, researchers enrolled men from the Prostate Cancer Outcomes Study (PCOS) in whom prostate cancer had been diagnosed in 1994 or 1995. The cohort comprised 1,655 men with localized prostate cancer between the ages of 55 and 74 years who had undergone either surgery (1,164 men) or radiotherapy (491 men). Functional status was assessed at baseline and at two, five and 15 years after diagnosis.
Results appeared online Jan. 31 at the New England Journal of Medicine.
Patients were more likely to have urinary incontinence after prostatectomy than radiotherapy at two years (odds ratio [OR], 6.22; 95% CI, 1.92 to 20.29) and five years (OR, 5.10; 95% CI, 2.29 to 11.36). However, no significant between-group difference was seen at 15 years. Patients were more likely to have erectile dysfunction after prostatectomy than radiotherapy at two years (OR, 3.46; 95% CI, 1.93 to 6.17) and five years (OR, 1.96; 95% CI, 1.05 to 3.63), but no significant difference was seen at 15 years. Patients were less likely to have bowel urgency after prostatectomy than radiotherapy at two years (OR, 0.39; 95% CI, 0.22 to 0.68) and five years (OR, 0.47; 95% CI, 0.26 to 0.84), but there was no significant difference at 15 years.
Researchers noted that men undergoing either prostate cancer treatment had declines in all functional outcomes throughout early, intermediate and long-term follow-up. For example, at 15 years, erectile dysfunction was nearly universal, affecting 87% in the prostatectomy group and 93.9% of those in the radiotherapy group. But only 43.5% of men in the prostatectomy group and 37.7% of those in the radiotherapy group reported being bothered by this, which the authors attributed to declining sexual interest with age or acceptance of sexual dysfunction over time.
They wrote, “Considering the often long duration of survival after treatment for prostate cancer, these data may be used to counsel men considering treatment for localized disease.”