Twenty-year Patient-reported Outcomes After Surgery, Radiotherapy, or Brachytherapy for Localized Prostate Cancer.

Area of Science:

• Urology
• Oncology
• Patient-Reported Outcomes

Background:

• Localized prostate cancer treatment options include radical prostatectomy (RP), external beam radiotherapy (EBRT), and brachytherapy.
• Long-term patient-reported outcomes comparing these treatments are crucial for informed decision-making.

Purpose of the Study:

• To compare the long-term impact of RP, EBRT, and brachytherapy on patient-reported outcomes up to 20 years post-treatment for localized prostate cancer.
• To analyze differences in urinary, sexual, bowel, and hormonal function over two decades.

Main Methods:

• Prospective observational study of men with localized prostate cancer (T1-T2, low/intermediate risk).
• Utilized Expanded Prostate Cancer Index Composite (EPIC-26) and Short Form-36 (SF-36) questionnaires administered annually.
• Employed generalized estimating equation models with propensity score-based weights to mitigate selection bias.

Main Results:

• Radical prostatectomy (RP) group showed significant worsening in most patient-reported outcomes.
• Radiotherapy groups (EBRT and brachytherapy) reported significantly less urinary incontinence deterioration compared to RP.
• Brachytherapy group experienced less sexual function decline compared to RP and EBRT over 20 years.

Conclusions:

• Long-term follow-up reveals distinct patterns of side effects for localized prostate cancer treatments.
• Urinary incontinence is highest after RP, while sexual function decline is least after brachytherapy at 20 years.
• These persistent differences should be integrated into shared decision-making for personalized prostate cancer care.