The following is a summary of “Functional outcomes after prostate cancer treatment: A comparison between single and multiple modalities,” published in the February 2023 issue of Urologic Oncology by Muise, et al.
The functional consequences of treatment for prostate cancer, a common and curable disease, can significantly impact the quality of life of those who survive the disease. To compare the rates of diagnosis and treatment of common functional side effects of surgery, radiation, or a combination of the 2, researchers performed a retrospective review of the SEER-Medicare database to identify patients who underwent prostate cancer treatment between January 1, 2004, and December 31, 2013. Researchers examined data from 67,527 patients.
Patients who underwent Radiation therapy (RT) alone had a lower risk of urethral stricture disease compared to Radical Prostatectomy (RP) only (8.44%, 95% CI 8.1%-8.8% vs. 5.35%, 95% CI 4.9%-5.9%, P<0.0001) and a lower risk of erectile dysfunction (30.4%, 95% CI 29.9%-30.9% vs. 56.1%, 95% CI 55.1%-57.04%, P< 0.0001). Higher rates of incontinence medication use (12.0% 95% CI 10.8%-13.2% vs. 9.8%, 95% CI 9.5%-10.1% for RT-only and 8.3%, 95% CI 7.8%-8.8% for RP-only, P< 0.0001), overall incontinence therapy (18.5%, 95%CI 17.1%-20.0% vs. 10.2%, 95% CI 9.9%-10.5% for RT-only and 14.9%, 95% CI Treatment rates for stricture (25.4%) and fistula (1.0%) were significantly greater in the RT-then-RP group than in the other groups (RT-only, 9.1%; RP-then-RT, 12.7%); and 0.092% for RP-then-RT).
Conditions like erectile dysfunction, incontinence, urethral stricture disease, irritative cystitis, and proctitis are more likely to improve with multimodality therapy in patients over 65. When radiation is used after a prostatectomy, functional outcomes tend to be much poorer. Men with prostate cancer who are having or planning to undertake multimodality therapy should be warned that they run the risk of worsening functional results.
Source: sciencedirect.com/science/article/abs/pii/S1078143922002745
