Health outcomes after prostatectomy or radiotherapy for prostate cancer: Results from the prostate cancer outcomes study

Background: Radical prostatectomy and external beam radiotherapy are the tw o major therapeutic options for treating clinically localized prostate canc er, Because survival is often favorable regardless of therapy, treatment de cisions may depend on other therapy-specific health outcomes. In this study , we compared the effects of two treatments on urinary, bowel, and sexual f unctions and on general health-related quality-of-life outcomes over a 2-ye ar period following initial treatment, Methods: A diverse cohort of patient s aged 55-74 years who were newly diagnosed with clinically localized prost ate cancer and received either radical prostatectomy (n = 1156) or external beam radiotherapy (n = 435) were included in this study. A propensity scor e was used to balance the two treatment groups because they differed in som e baseline characteristics. This score was used in multivariable cross-sect ional and longitudinal regression analyses comparing the treatment groups, All statistical tests were two-sided, Results: Almost 2 years after treatme nt, men receiving radical prostatectomy were more likely than men receiving radiotherapy to be incontinent (9.6% versus 3.5%; P<.001) and to have high er rates of impotence (79.6% versus 61.5%; P<.001), although large, statist ically significant declines in sexual function were observed in both treatm ent groups. In contrast, men receiving radiotherapy reported greater declin es in bowel function than did men receiving radical prostatectomy, All of t hese differences remained after adjustments for propensity score. The treat ment groups were similar in terms of general health-related quality of life . Conclusions: There are important differences in urinary, bowel, and sexua l functions over 2 years after different treatments for clinically localize d prostate cancer. In contrast to previous reports, these outcome differenc es reflect treatment delivered to a heterogeneous group of patients in dive rse health care settings. These results provide comprehensive and represent ative information about long-term treatment complications to help guide and inform patients and clinicians about prostate cancer treatment decisions.