San Antonio, Texas USA (UroToday.com) Patient-reported outcomes (PROs) are critical to a patient-centered treatment approach. In prostate cancer, PROs such as erectile dysfunction and urinary incontinence have a large impact on health-related quality of life. Yet, little is known regarding how these outcomes may vary by disease severity.
The authors used data from the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study which prospectively enrolled men with localized prostate cancer in 2011 and 2012. PROs were measured using the Expanded Prostate Index Composite (EPIC) at baseline, 6, 12, and 36 months after treatment. A model was developed to assess the effect of treatment on EPIC domain scores by disease severity. Variables included in the model were 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.
More than 2500 patients who underwent treatment for prostate cancer were included: 1155 (45%) had low risk, 983 (39%) had intermediate, and 417 (16%) had high risk disease. For patients with low risk disease, radical prostatectomy (RP) was associated with more severe decreases in sexual function compared to external beam radiation therapy (EBRT) at 3 years (-14.3 for RP relative to EBRT; 95%CI -18.56, -10.53). However, these differences were tempered and nonsignificant in the high risk cohort (-4.46 for RP relative to EBRT; 95% CI -9.79, 0.88). In the urinary incontinence domain, both patients with low risk and high risk disease demonstrated worse functional outcomes with RP relative to EBRT at 3 years (low risk -14.6: 95% CI -18.00, -11.19; high risk -19.25: 95% CI -23.87, -14.62).
Interestingly, these data suggest that the effect of treatment on urinary and sexual function may differ by disease severity. In the high risk population, sexual function domains are similar; however larger declines in urinary function domains are noted. One potential limitation to this study is that it is unclear whether patients who received adjuvant or salvage radiation post-prostatectomy were removed from the study cohort. If these patients were included, urinary function post-prostatectomy may be worse. In addition, a breakdown of robotic versus open prostatectomies would be helpful. overall, however, PROs are critical in reducing information asymmetry regarding treatment options. Only when they included in the discussion alongside the oft included oncologic outcome data is shared decision-making optimized.
Written By: Benjamin T. Ristau, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center
17th Annual Meeting of the Society of Urologic Oncology - November 30 -December 2, 2016 – San Antonio, Texas USA