The CEASAR study is a prospective, population-based, observational study which enrolled men with localized prostate cancer in 2011 and 2012. Patient-reported function was measured using the 26-item Expanded Prostate Index Composite (EPIC) at baseline, 6, 12, and 36 months after treatment. To identify differences in the effect of treatment on EPIC domain scores by disease risk, the authors fit a set of longitudinal models with interactions between disease risk and treatment type (radical prostatectomy [RP] or external beam radiotherapy [EBRT]) adjusting for the: time since treatment, pre-treatment function, age, race, comorbidity, educational attainment, insurance type, employment, marital status, physical function score, social support, depression score, participatory decision-making score, and study site.
Among the 2544 participants, 1144 (45%) had low-risk, 983 (39%) had intermediate-risk, and 417 (16%) had high-risk disease. Among low-risk patients, RP caused more severe decreases in sexual function compared to EBRT at 3 years (mean difference in EPIC score: -14.30 [95% CI: -18.56, -10.53]); however, among high-risk patients, this difference became both clinically and statistically insignificant (-4.46 [-9.79, 0.88]). With respect to incontinence, RP lead to even greater declines in function among high-risk patients compared to EBRT at 3 years (difference in treatment effects among low risk: -14.60 [-18.00, -11.19] and high risk: -19.25 [-23.87, -14.62]). No clinically significant interactions between treatment and risk were detected among the bowel, hormone, or urinary irritative domains.
These data suggest that PCa disease risk causes various treatment effects on urinary incontinence and sexual function. Namely, high-risk patients report similar sexual function at 3 years regardless of what treatment they received, but have more drastic declines in urinary incontinence after surgery.
Presented By: Mark Tyson, Nashville, TN
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA