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    Studies: PCa treatments differ in QoL outcomes

    Two new large studies appearing in the JAMA document quality-of-life outcomes associated with various approaches to the management of localized prostate cancer. The studies confirm a higher rate of sexual and urinary side effects with radical prostatectomy (RP) compared with radiation therapy and surveillance.

    The knowledge gained from these studies is critical for shared decision-making, as quality-of-life issues often guide management decisions in men with low-risk prostate cancer, the authors maintain.

    In the first study, investigators led by Daniel Barocas, MD, MPH, examined functional outcomes and adverse effects of 2,250 men 80 years of age and younger who were diagnosed in 2011-2012 with clinical stage cT1-2 localized prostate cancer (JAMA 2017; 317:1126-40). All men had a PSA <50 ng/mL. They were identified from five Surveillance, Epidemiology, and End Results registries in Atlanta, Los Angeles, Louisiana, New Jersey, and Utah, and the Cancer of the Prostate Strategic Urologic Research Endeavor registry. The study included follow-up through August 2015.

    Of the 2,550 men, 1,523 underwent RP, 598 were treated with external beam radiation (EBRT), and 429 were managed with active surveillance. About three-fourths of the cohort was Caucasian. The primary outcome measures were the domain scores on the 26-item Expanded Prostate Cancer Index Composite, which ranges from 0 to 100 (higher scores indicate better function), at 3 years.

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    After adjustment for baseline domain scores and other covariates, the decline in sexual domain scores was 11.9 points greater in the RP group compared with the cohort that underwent EBRT and 16.2 points greater than those who were managed by active surveillance. The decline in sexual domain scores was not significantly different between the EBRT and active surveillance groups at 3 years.

    “Erectile dysfunction 3 years after treatment was more common in men treated with surgery than radiation. But this difference was only evident in the 25% of men with excellent function before treatment,” said Dr. Barocas, of Vanderbilt University, Nashville, TN. “Men with erectile dysfunction before treatment have ‘less to lose’ and end up having low function regardless of which treatment they choose.”

    Urinary incontinence was worse after RP compared with baseline, whereas men in the other two groups did not have a significant change in urinary incontinence score from baseline. At 3 years, adjusted mean incontinence scores were 12.7 points worse for RP compared with active surveillance and 18.0 points worse compared with EBRT. Both of these differences were considered clinically meaningful; the minimal clinically important difference was defined as at least 6 points. Urinary incontinence was reported as a moderate or big problem in 14% of men 3 years after RP compared with 5% who had EBRT.

    Urinary irritative scores improved in men undergoing RP and changed little or were unchanged in men in the EBRT and active surveillance groups. There were no significant differences between groups in bowel or hormonal function beyond 12 months, and no meaningful differences in health-related quality of life, the authors found.

    Three-year prostate cancer-specific survival was excellent in all three groups at >99%.

    Next: What second study found

    Wayne Kuznar
    Wayne Kuznar is a contributor to Urology Times.

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