Localized prostate cancer: long-term patient reported outcomes

  • Hoffman KE & al.
  • JAMA
  • 14 Jan 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • At 5 years, patients with localized prostate cancer treated with prostatectomy show a clinically meaningful decline in:
    • Urinary function vs external beam radiation (EBRT) and low-dose-rate brachytherapy (LDR-brachytherapy) in the favorable-risk group.
    • Sexual function vs EBRT+androgen deprivation therapy (ADT) in the unfavorable-risk group.

Why this matters

  • These findings can help patients make informed treatment decisions.

Study design

  • 2005 patients with clinically localized prostate cancer participated in a survey of patient-reported outcomes (functional outcomes and health-related QoL).
  • Favorable-risk patients (n=1386) received prostatectomy, active surveillance, EBRT, or LDR-brachytherapy.
  • Unfavorable-risk patients (n=619) received either prostatectomy or EBRT+ADT.
  • Funding: US Agency for Healthcare Research and Quality.

Key results

  • Median follow-up: 73 months.
  • Favorable-risk group:
    • At 5 years, nerve-sparing prostatectomy showed clinically meaningful decline in urinary incontinence vs EBRT (AMD, prostatectomy, −15.9; P<.001 and ldr-brachytherapy p>
    • Urinary irritative score improved with prostatectomy vs LDR-brachytherapy (AMD, 5.4; P<.001>
  • Unfavorable-risk group:
    • At 5 years, sexual function score declined with both treatments.
    • EBRT+ADT was associated with clinically better sexual function vs prostatectomy (AMD, 12.5; P<.001>
  • No clinically meaningful difference was seen in sexual, bowel, hormone function scores, and health-related QoL between treatments at 5 years in either risk group.

Limitations

  • Survey-based study.