Functional outcomes after prostate cancer treatment: A comparison between single and multiple modalities

Area of Science:

• Urology
• Oncology
• Medical Outcomes Research

Background:

• Prostate cancer treatments significantly affect survivors' quality of life due to functional side effects.
• Understanding the comparative rates of these side effects across different treatment modalities is crucial for patient counseling and care.

Purpose of the Study:

• To compare the rates of diagnosis and treatment of common functional side effects following prostate cancer treatment with radical prostatectomy (RP)-only, radiation therapy (RT)-only, or combined modalities.
• To evaluate the impact of treatment sequencing on functional outcomes.

Main Methods:

• Retrospective review of the SEER-Medicare database (2004-2013).
• Analysis of 67,527 patients undergoing prostate cancer treatment.
• Comparison of functional outcomes including erectile dysfunction, urinary incontinence (UI), urethral stricture, cystitis, and proctitis.

Main Results:

• RT-only was associated with lower rates of erectile dysfunction and UI compared to RP-only.
• RT-only had higher rates of urethral stricture, cystitis, and proctitis than RP-only.
• Combined modality treatments, particularly RP then RT, showed higher rates of incontinence and stricture therapy.
• RT followed by RP (RT-then-RP) demonstrated the highest rates of stricture and fistula treatment.

Conclusions:

• Multimodality therapy for prostate cancer, especially in patients over 65, is linked to higher treatment rates for adverse functional outcomes.
• Radiation therapy followed by radical prostatectomy is associated with significantly worse functional outcomes.
• Patients should be informed about the increased risk of declining functional outcomes with multimodality treatment approaches.