Bladder outlet obstruction (BOO) after prostate cancer therapy (PCT) imposes a significant burden on the health and quality of life in men. Our objective was to describe the burden of BOO after PCT by detailing the type of procedures performed and how often those procedures are repeated in men with recurrent BOO.
Using SEER-Medicare linked data from 1992-2007 with follow-up through 2009, we identified 12,676 men who underwent at least one BOO procedure after PCT (n=3,994; 1,485; 1,847; 4,736; 369 and 245 receiving external beam radiotherapy (EBRT), brachytherapy (BT), BT+EBRT, radical prostatectomy (RP), RP+EBRT, and cryotherapy, respectively. Histogram, incidence rates and Cox proportional hazards models with repeated events analysis were used to describe the burden of repeat BOO treatments, stratified by PCT type. We described the type of BOO surgery, grouped by level of invasiveness.
With a median follow-up was 8. 8 years, 44. 6% of men received 2 or more BOO procedures. Men treated with BT (HR=1. 2; p<0. 05) and BT+EBRT (HR=1. 32; p<0. 05) were at increased adjusted risk of repeated BOO treatment when compared to RP men. After stricture incision, RP and RP+EBRT-treated men were most likely to undergo dilation (34. 7-35. 0%) whereas stricture resection/ablation was more common after BT, EBRT or BT+EBRT (28. 9-41. 2%).
Almost half of men with BOO after PCT undergo more than one procedure. Further, men with BOO after radiotherapy, undergo more invasive endoscopic therapies and have a higher risk of requiring multiple treatments than men with BOO after RP.
The Journal of urology. 2015 Dec 09 [Epub ahead of print]
Daniel Liberman, Stephanie Jarosek, Beth A Virnig, Haitao Chu, Sean P Elliott
Department of Urology, University of Minnesota, Minneapolis, USA. , Department of Urology, University of Minnesota, Minneapolis, USA. , Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA. , Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA. , Department of Urology, University of Minnesota, Minneapolis, USA.