Long-term urinary complications in patients with localized prostate cancer treated with radiotherapy and/or radical...

Although short-term complications of external beam radiotherapy (EBRT), radical prostatectomy (RP), or a combination of both (RP/EBRT) for prostate cancer have been extensively reported, data on long-term complications are under-reported. The primary objective was to compare the rates and severity of long-term genitourinary (GU) toxicity of EBRT, RP, and RP/EBRT. The secondary objective was to assess patient- and treatment-related risk factors for GU toxicity.

We retrospectively examined the charts of prostate cancer patients who received EBRT, RP, or RP/EBRT between 2010 and 2018 at Sherbrooke University Hospital Center (QC, Canada). Baseline patient characteristics, treatment-related information, and late GU complications (> 1-year post-treatment) were extracted.

The study included 1246 patients, of which 694 (55.7%), 380 (30.5%), and 172 (13.8%) received EBRT, RP, and RP/EBRT, respectively. Mean follow-up was 6.2 years (range, 1.5-12.2). Based on the Common Terminology Criteria for Adverse Events, EBRT group had 202 (29.1%) grade 2 and 38 (5.5%) grade 3 complications, compared to 66 (17.4%) grade 2 and 32 (8.4%) grade 3 for RP patients (p < 0.001). The RP/EBRT group had 58 (33.7%) grade 2 and 29 (16.9%) grade 3 complications (p < 0.001). No patient-related risk factor significantly increased the rate of GU toxicity, except for anticoagulation.

Patients who underwent RP/EBRT had the highest rate and severity of complications. Although EBRT patients had a higher rate of GU toxicity, it was less severe than RP patients. This reinforces the importance of fully disclosing risks and types of complications when discussing treatment options.