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Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
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Functional Outcomes After Localized Prostate Cancer Treatment
Bashir Al Hussein Al Awamlh1, Christopher J D Wallis2,3, David F Penson1,4
1Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA
|January 23, 2024
Summary
Radical prostatectomy for localized prostate cancer increased urinary incontinence but not sexual dysfunction compared to other treatments. External beam radiotherapy with androgen deprivation therapy worsened bowel and hormone function.
Area of Science:
- Urology
- Oncology
- Health Services Research
Background:
- Adverse outcomes of localized prostate cancer treatments are not fully understood.
- Patient-reported functional outcomes are crucial for treatment decision-making.
Purpose of the Study:
- To compare functional outcomes (sexual, urinary, bowel, hormone) at 10 years post-treatment for localized prostate cancer.
- To evaluate the impact of radical prostatectomy, radiotherapy, brachytherapy, and active surveillance on functional outcomes.
Main Methods:
- Observational cohort study using US SEER data (2011-2012).
- Included 2445 patients with favorable or unfavorable localized prostate cancer.
- Assessed patient-reported outcomes using the Expanded Prostate Cancer Index Composite at 10-year follow-up.
Main Results:
- Radical prostatectomy (RP) was linked to worse urinary incontinence vs. active surveillance (AS) in favorable-prognosis disease.
- RP did not show worse sexual function vs. AS in favorable-prognosis disease.
- In unfavorable-prognosis disease, RP worsened urinary incontinence vs. external beam radiotherapy with androgen deprivation therapy (EBRT+ADT); EBRT+ADT worsened bowel and hormone function vs. RP.
Conclusions:
- Radical prostatectomy is associated with increased urinary incontinence but not sexual dysfunction compared to radiotherapy or surveillance for favorable-prognosis prostate cancer.
- For unfavorable-prognosis disease, radical prostatectomy leads to worse urinary incontinence, while EBRT+ADT leads to worse bowel and hormone function compared to RP.
