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Master of Public Health

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

De B , Pasalic D , Barocas DA , Wallis CJD , Huang LC , Zhao Z , Koyama T , Tang C , Conwill R , Goodman M , Hamilton AS , Wu XC , Paddock LE , Stroup A , Cooperberg MR , Hashibe M , O'Neil BB , Kaplan SH , Greenfield S , Penson DF , Hoffman KE , . The Journal of urology. 2022 8 25; (). 101097JU0000000000002902

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.

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