Patient-Reported Outcomes after External Beam Radiotherapy with Low Dose-Rate Brachytherapy Boost versus Radical Prostatectomy for Localized Prostate Cancer: Five-Year Results from a Prospective Comparative Effectiveness Study.

Data comparing radical prostatectomy (RP) and external beam radiation therapy with low-dose rate brachytherapy boost (EBRT-LDR) are lacking. To better guide shared decision-making regarding treatment, we compared patient reported outcomes (PROs) through 5 years following RP or EBRT-LDR for localized prostate cancer.

From 2011-2012, men aged<80 years with localized prostate adenocarcinoma were enrolled and followed longitudinally. PROs included the Expanded Prostate Index Composite. Regression models adjusted for baseline scores and covariates were constructed.

The study population included 112 men treated with EBRT-LDR and 1553 treated with RP. Compared to RP, EBRT-LDR was associated with clinically meaningful worse urinary irritative/obstructive (adjusted mean score difference [95% confidence interval]: 5.0 [-8.7, -1.3]; p=0.008 at 5 years) and better urinary incontinence function (13.3 [7.7, 18.9]; p<0.001 at 5 years) through 5 years. Urinary function bother was similar between groups (p>0.4 at all timepoints). Treatment with EBRT-LDR was associated with worse bowel function (-4.0 [-6.9, -1.1]; p=0.006 at 5 years) through 5 years compared to RP. Treatment with EBRT-LDR was associated with better sexual function at 1 year (12.0 [6.5, 17.5]; p<0.001 at 1 year) compared to RP, but there was insufficient evidence to reject the supposition that no difference was seen at 3 or 5 years.

Compared to RP, EBRT-LDR was associated with clinically meaningful worse urinary irritative/obstructive and bowel functions but better urinary incontinence function through 5 years after treatment. These patient-reported functional outcomes may clarify treatment expectations and help inform treatment choices for localized prostate cancer.

The Journal of urology. 2022 Aug 25 [Epub ahead of print]

Brian De, Dario Pasalic, Daniel A Barocas, Christopher J D Wallis, Li-Ching Huang, Zhiguo Zhao, Tatsuki Koyama, Chad Tang, Ralph Conwill, Michael Goodman, Ann S Hamilton, Xiao-Cheng Wu, Lisa E Paddock, Antoinette Stroup, Matthew R Cooperberg, Mia Hashibe, Brock B O'Neil, Sherrie H Kaplan, Sheldon Greenfield, David F Penson, Karen E Hoffman

The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, Texas., Vanderbilt University Medical Center, Department of Urology, Nashville, Tennessee., Mount Sinai Hospital, Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Vanderbilt University Medical Center, Department of Biostatistics, Nashville, Tennessee., Vanderbilt University Medical Center, Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Nashville, Tennessee., Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia., Keck School of Medicine at the University of Southern California, Department of Preventative Medicine, Los Angeles, California., Louisiana State University New Orleans School of Public Health, Department of Epidemiology, New Orleans, Louisiana., Cancer Institute of New Jersey, Rutgers Health, Department of Epidemiology, New Brunswick, New Jersey., University of California San Francisco, Department of Urology, San Francisco, California., University of Utah School of Medicine, Department of Family and Preventative Medicine, Salt Lake City, Utah., University of Utah Health, Department of Urology, Salt Lake City, Utah., University of California Irvine, Department of Medicine, Irvine, California.