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15-01-2020 | Oncology | News | Article

Prostatectomy-associated urinary incontinence disparities persist at 5 years

medwireNews: Men with favorable- and unfavorable-risk prostate cancer who undergo prostatectomy report worse urinary incontinence at 5 years than men treated with other contemporary management options, US research shows.

By contrast, treatment-related differences in other functional outcomes, such as sexual function, decline with time, report Karen Hoffman (The University of Texas MD Anderson Cancer Center, Houston) and colleagues in JAMA.

They say their findings “may clarify expectations and enable men to make informed choices about care.”

The study included 1386 men with favorable-risk prostate cancer (cT1 to cT2bN0M0, PSA ≤20 ng/mL, Grade Group 1–2) and 619 men with unfavorable-risk (cT2cN0M0, PSA 20–50 ng/mL, or Grade Group 3–5) disease diagnosed in 2011 and 2012.

The men used the 26 item Expanded Prostate Index Composite (range, 0–100 with higher scores indicating better function) to record functional outcomes at 6 months, 1 year, 3 years, and 5 years, posttreatment.

In the current, 5-year analysis, men with favorable-risk disease who underwent nerve-sparing prostatectomy (n=675) had clinically meaningful worse urinary incontinence than men who underwent active surveillance (n=363; mean difference 10.9 points), external beam radiation therapy (EBRT, n=261; 15.9 points), and low-dose-rate (LDR) brachytherapy (n= 87; 11.6 points) after adjustment for baseline function, and patient and tumor characteristics.

By contrast, there were no clinically meaningful differences in sexual function among the treatment groups at 5 years, even though patients who underwent prostatectomy reported worse outcomes than the other treatments at earlier timepoints.

In addition, there were no clinically meaningful differences between EBRT and active surveillance for urinary, sexual, and bowel function outcomes throughout the 5-year period, and between LDR brachytherapy and active surveillance from 1 year onwards.

Among the men with unfavorable-risk disease, prostatectomy (n=402) was associated with clinically meaningful worse urinary incontinence (23.2 points) and sexual function (12.5 points) at 5 years relative to EBRT with androgen deprivation therapy (n=217). But there were no significant 5-year differences between the groups with regards to bowel or hormone function.

Of note, there were no statistically significant differences among the groups in either prostate cancer survival or general quality of life according to the 36-Item Short Form Survey.

Hoffman et al therefore say: “Because the treatment options evaluated in this study were associated with similar prostate cancer survival and global health-related quality of life through the first 5 years, the differences in urinary, bowel, sexual, and hormonal function are the most salient outcomes during this period and may drive patient treatment selection.”

They add: “Other factors, including patient preference, perception of long-term oncologic effectiveness, time commitment for treatment and recovery, out-of-pocket expenses, salvage treatment options, and provider biases and recommendation, also affect treatment choice.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

JAMA 2020; 323: 149–163

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