OBJECTIVE: To evaluate long-term urinary, sexual and bowel functional outcomes after prostate cancer treatment at a median follow-up of 12 years (IQR 11-13).
PATIENTS AND METHODS: In this nationwide, population-based study, we identified from the National Prostate Cancer Register, Sweden, 6,003 men diagnosed with localized prostate cancer (clinical local stage T1-2, any Gleason score, prostate specific antigen < 20 ng/mL, NX or N0, MX or M0) between 1997 and 2002 who were ≤ 70 years at diagnosis. 1,000 prostate cancer-free controls were selected, matched for age and county of residence. Functional outcomes were evaluated with a validated self-reported questionnaire.
RESULTS: Responses were obtained from 3,937/6,003 cases (66%) and 459/1,000 (46%) controls. Twelve years post diagnosis, at a median age of 75 years, the proportion of cases with adverse symptoms was 87% for erectile dysfunction or sexually inactive, 20% for urinary incontinence and 14% for bowel disturbances. The corresponding proportions for controls were 62%, 6% and 7%, respectively. Men with prostate cancer, except those on surveillance, had an increased risk of erectile dysfunction, compared to control men. Radical prostatectomy was associated with increased risk of urinary incontinence (odds ratio; OR 2.29 [95% CI 1.83-2.86] and radiotherapy increased the risk of bowel dysfunction (OR 2.46 [95% CI 1.73-3.49]) compared to control men. Multi-modal treatment, in particular including androgen deprivation therapy (ADT), was associated with the highest risk of adverse effects; for instance radical prostatectomy followed by radiotherapy and ADT was associated with an OR of 3.74 [95 CI 1.76-7.95] for erectile dysfunction and OR 3.22 [95% CI 1.93-5.37] for urinary incontinence.
CONCLUSION: The proportion of men who suffer long-term impact on functional outcomes after prostate cancer treatment was substantial.
Carlsson S, Drevin L, Loeb S, Widmark A, Franck Lissbrant I, Robinson D, Johansson E, Stattin P, Fransson P. Are you the author?
Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A; Department of Urology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden; Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden; New York University and Manhattan Veterans Affairs Medical Center, New York, NY, U.S.A; Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden; Department of Oncology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden; Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden; Department of Urology, Ryhov County Hospital, Jönköping, Sweden; Department of Surgical Sciences, University Hospital of Uppsala, Uppsala, Sweden; Department of Nursing, Umeå University, Umeå, Sweden.
Reference: BJU Int. 2015 May 8. Epub ahead of print.