Association Between Receipt of Definitive Treatment for Localized Prostate Cancer and Adverse Health Outcomes: A...

Area of Science:

• Oncology
• Urology
• Geriatric Medicine

Background:

• Localized prostate cancer treatment decisions involve weighing efficacy against potential adverse health outcomes.
• Understanding the comparative risks of different definitive treatments is crucial for patient-physician shared decision-making.

Purpose of the Study:

• To analyze adverse health outcomes following definitive treatments for localized prostate cancer.
• To compare the risks of urinary incontinence, erectile dysfunction, and bowel dysfunction among prostatectomy, intensity-modulated radiation therapy (IMRT), and brachytherapy.

Main Methods:

• A cohort of men aged 65+ with localized prostate cancer was identified from four state cancer registries (2006-2013).
• Registry data were linked with Medicare enrollment and claims to identify treatment and adverse outcomes.
• Adverse outcomes were modeled in two stages: treatment choice and probability of adverse events post-treatment.

Main Results:

• 81.4% of 61,187 men received definitive treatment; 18.6% underwent active surveillance.
• Active surveillance was associated with minimal adverse health outcomes (0.16%-0.75%).
• Prostatectomy showed higher risks of urinary incontinence and erectile dysfunction compared to brachytherapy and IMRT. IMRT demonstrated lower risks for erectile dysfunction, urinary incontinence, and urinary dysfunction compared to brachytherapy.

Conclusions:

• Definitive treatments for localized prostate cancer are associated with varying risks of adverse health outcomes.
• Active surveillance presents a lower risk profile for adverse events.
• This comparative data can inform patient-physician discussions on treatment selection.