In 2 recent reports published in the JAMA, researchers showed remarkably similar patterns for patient-reported outcomes (PROs), suggesting that prostatectomy results in worse sexual function and urinary incontinence compared with radiation and active surveillance.1,2

Patients who opted for external beam radiotherapy (EBRT) and brachytherapy had worse short-term urinary obstruction and irritation. By 2 years, however, no significant differences were reported for most domains between treatment groups and active surveillance.

These studies provide men diagnosed with localized prostate cancer with important information about the adverse events of each treatment choice so that sound clinical decisions can be made, according to an accompanying editorial.3

The short-term outcomes reported in the studies complement those seen in the 10-year, long-term prospective study (ProtecT).4

“Despite differences in the study design and the populations being studied, the message is consistent across all 3 studies that each form of prostate cancer treatment has a different impact on quality of life over time,” Stacy Loeb, MD, assistant professor of urology and population health at New York University Langone Medical Center, told Cancer Therapy Advisor.

“They provide very useful information for men with newly diagnosed prostate cancer to help them make decisions about their treatment.” 

The SEER Registry Study

In the first study, PROs from men with localized prostate cancer were collected at enrollment, 6, 12, and 36 months after enrollment. Of 2550 men enrolled, 59.7% underwent radical prostatectomy, 23.5% underwent EBRT, and 16.8% underwent active surveillance/watchful waiting.

After controlling for baseline domain scores, radical prostatectomy was associated with the largest decline in sexual function vs EBRT or surveillance. EBRT was also associated with worse sexual function compared with active surveillance at 12 months, but the magnitude of decline after 3 years was not significant. More men (44%) reported sexual dysfunction at 3 years compared with EBRT (35%) and surveillance (28%).

Decline in urinary incontinence was also significant for men who underwent radical prostatectomy. No significant change was seen with EBRT or surveillance.

Decline in bowel function was not common, though the bowel urgency at 3 years was least likely for men who underwent radical prostatectomy.

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Hormone function declined more for EBRT than for surveillance and radical prostatectomy at 6 months, though these differences were not significant after 3 years.