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Prostate cancer treatments like prostatectomy and radiotherapy significantly increase the risk of long-term urinary, sexual, and other complications. These findings emphasize the need for careful patient counseling regarding prostate cancer (PCA) treatment risks and benefits.

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Area of Science:

  • Oncology
  • Urology
  • Geriatric Medicine

Background:

  • Prostate cancer (PCA) is often indolent, necessitating a careful balance between cancer control and treatment-associated morbidities.
  • Treatment decisions for PCA require weighing potential benefits against risks of long-term adverse effects.

Purpose of the Study:

  • To compare long-term treatment-related adverse effects and complications in patients treated for PCA versus a general population of older males.
  • To quantify the increased hazard risk of specific complications following prostatectomy and radiotherapy for PCA.

Main Methods:

  • A cohort study linked data from two large PCA prevention clinical trials with Medicare claims records.
  • Included patients with PCA treated with prostatectomy or radiotherapy, compared to an untreated control group.
  • Multivariable Cox regression analysis was used, adjusting for relevant covariates and stratified by study arm.

Main Results:

  • Prostatectomy was associated with a 7.23-fold increased hazard risk of urinary or sexual complications, while radiotherapy showed a 2.76-fold increase compared to untreated individuals.
  • Radiotherapy patients had a nearly 3-fold higher risk of bladder cancer and significantly increased risks of radiation cystitis and proctitis.
  • The incidence of any treatment-related complication per 1000 person-years was 124.26 for prostatectomy, 62.15 for radiotherapy, and 23.61 for untreated participants.

Conclusions:

  • PCA treatment is linked to higher complication rates in the 12 years post-treatment, even after accounting for age-related factors.
  • Findings underscore the importance of patient counseling on PCA screening and treatment risks.
  • Provides a rationale for prioritizing prostate cancer prevention strategies.