Patient-Reported Outcomes after External Beam Radiotherapy with Low Dose-Rate Brachytherapy Boost versus Radical Prostatectomy for Localized Prostate Cancer: Five-Year Results from a Prospective Comparative Effectiveness Study
AUTHORS
- PMID: 36006050 [PubMed].
ABSTRACT
BACKGROUND: Data comparing radical prostatectomy (RP) and external beam radiation therapy with low-dose rate brachytherapy boost (EBRT-LDR) are lacking. To better guide shared decision-making regarding treatment, we compared patient reported outcomes (PROs) through 5 years following RP or EBRT-LDR for localized prostate cancer.
METHODS: From 2011-2012, men aged<80 years with localized prostate adenocarcinoma were enrolled and followed longitudinally. PROs included the Expanded Prostate Index Composite. Regression models adjusted for baseline scores and covariates were constructed.
RESULTS: The study population included 112 men treated with EBRT-LDR and 1553 treated with RP. Compared to RP, EBRT-LDR was associated with clinically meaningful worse urinary irritative/obstructive (adjusted mean score difference [95% confidence interval]: 5.0 [-8.7, -1.3]; p=0.008 at 5 years) and better urinary incontinence function (13.3 [7.7, 18.9]; p<0.001 at 5 years) through 5 years. Urinary function bother was similar between groups (p>0.4 at all timepoints). Treatment with EBRT-LDR was associated with worse bowel function (-4.0 [-6.9, -1.1]; p=0.006 at 5 years) through 5 years compared to RP. Treatment with EBRT-LDR was associated with better sexual function at 1 year (12.0 [6.5, 17.5]; p<0.001 at 1 year) compared to RP, but there was insufficient evidence to reject the supposition that no difference was seen at 3 or 5 years.
CONCLUSION: Compared to RP, EBRT-LDR was associated with clinically meaningful worse urinary irritative/obstructive and bowel functions but better urinary incontinence function through 5 years after treatment. These patient-reported functional outcomes may clarify treatment expectations and help inform treatment choices for localized prostate cancer.
Tags: faculty publications 2022