The varying effects on urinary, bowel, and sexual function from treatments were not significant 15 years posttherapy
Researchers compared outcomes among prostate cancer patients treated with surgery and those treated with radiotherapy and discovered that differences in urinary, bowel, and sexual function exist after short-term follow-up. However, 15 years following initial treatment, those differences were no longer significant.
For the study, Matthew Resnick, MD, study leader and instructor in Urologic Surgery, Vanderbilt University Medical Center, and colleagues followed 1655 men between the ages of 55 and 74 years from the Prostate Cancer Outcomes Study group. While 1164 of the men (70.3%) had undergone prostatectomy, 491 (29.7%) had received radiotherapy. Upon enrollment, the patients completed a questionnaire regarding clinical and demographic issues and health-related quality of life. At set times following treatment, the men were asked about clinical outcomes and disease-specific quality-of-life issues.
Study results, published in the New England Journal of Medicine, show that men in the prostatectomy group were significantly more likely to report urinary leakage at 2 and 5 years following treatment compared with those who received radiation therapy. However, at 15 years posttreatment, no significant difference in the adjusted odds of urinary incontinence was found.
Compared with those in the radiotherapy group, the men in the prostatectomy group were also significantly more likely to report having problems with erectile dysfunction 2 years and 5 years after surgery.
“At the 2- and 5-year time points, men who underwent prostatectomy were more likely to suffer from urinary incontinence and erectile dysfunction than men who received radiation therapy,” said Resnick. “While treatment-related differences were significant in the early years following treatment, those differences became far less pronounced over time.”
Although there was initial evidence of treatment-dependent differences in patterns of sexual dysfunction, after 5 years both groups had a gradual decline in sexual function. After 15 years, erectile dysfunction was present in 87% of the prostatectomy group and 93.9% of the radiotherapy group. To this point, the authors noted that age may have played a role in the patients’ waning sexual function, as shown in unrelated studies.
With regard to bowel function, those who were treated with radiotherapy had more problems in the short term. Compared with those in the prostatectomy group, men in the radiotherapy group reported significantly higher rates of bowel urgency 2 and 5 years posttherapy. However, at 15 years, the researchers found no significant difference in the odds of bowel urgency, despite absolute differences in the prevalence of bowel urgency between the 2 groups.
“This study of 15-year outcomes represents a mature portrait of quality of life issues following prostate cancer treatment,” said senior study author David Penson, MD, MPH, Ingram Professor of Cancer Research, professor of Urologic Surgery and Medicine, and director of the Vanderbilt Center for Surgical Quality and Outcomes Research.
Physicians could use these data to counsel men who are considering treatment for localized disease, the authors suggest, since the median life expectancy after treatment for prostate cancer is 13.8 years.
Source: NCI.