Patient-reported Side Effects 1 Year After Radical Prostatectomy or Radiotherapy for Prostate Cancer: A Register-based Nationwide Study

Christian Corsini; Oskar Bergengren; Stefan Carlsson; Hans Garmo; Marie Hjelm-Eriksson; Per Fransson; Jon Kindblom; David Robinson; Marcus Westerberg; Pär Stattin; Sigrid V Carlsson

doi:10.1016/j.euo.2023.12.007

Patient-reported Side Effects 1 Year After Radical Prostatectomy or Radiotherapy for Prostate Cancer: A Register-based Nationwide Study

Eur Urol Oncol. 2024 Jan 16:S2588-9311(23)00295-X. doi: 10.1016/j.euo.2023.12.007. Online ahead of print.

Authors

Affiliations

¹ Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy.
² Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
³ Department of Urology, Karolinska University Hospital, Solna, Sweden.
⁴ Department of Oncology, St. Göran Hospital, Stockholm, Sweden.
⁵ Department of Nursing, Umeå University, Umeå, Sweden; Cancercentrum, Norrlands University Hospital, Umeå, Sweden.
⁶ Department of Oncology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Urology, Ryhov Hospital, Jönköping, Sweden.
⁸ Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden. Electronic address: carlssos@mskcc.org.

PMID: 38233329
DOI: 10.1016/j.euo.2023.12.007

Abstract

Background: Data on functional and psychological side effects following curative treatment for prostate cancer are lacking from large, contemporary, unselected, population-based cohorts.

Objective: To assess urinary symptoms, bowel disturbances, erectile dysfunction (ED), and quality of life (QoL) 12 mo after robot-assisted radical prostatectomy (RARP) and radiotherapy (RT) using patient-reported outcome measures in the Swedish prostate cancer database.

Design, setting, and participants: This was a nationwide, population-based, cohort study in Sweden of men who underwent primary RARP or RT between January 1, 2018 and December 31, 2020.

Outcome measurements and statistical analysis: Absolute proportions and odds ratios (ORs) were calculated using multivariable logistic regression, with adjustment for clinical characteristics.

Results and limitations: A total of 2557 men underwent RARP and 1741 received RT. Men who underwent RT were older (69 vs 65 yr) and had more comorbidities at baseline. After RARP, 13% of men experienced incontinence, compared to 6% after RT. The frequency of urinary bother was similar, at 18% after RARP and 18% after RT. Urgency to defecate was reported by 14% of men after RARP and 34% after RT. At 1 yr, 73% of men had ED after RARP, and 77% after RT. High QoL was reported by 85% of men after RARP and 78% of men after RT. On multivariable regression analysis, RT was associated with lower risks of urinary incontinence (OR 0.25, 95% confidence interval [CI] 0.19-0.33), urinary bother (OR 0.79, 95% CI 0.66-0.95), and ED (OR 0.54, 95% CI 0.46-0.65), but higher risk of bowel symptoms (OR 2.86, 95% CI 2.42-3.39). QoL was higher after RARP than after RT (OR 1.34, 95% CI 1.12-1.61).

Conclusions: Short-term specific side effects after curative treatment for prostate cancer significantly differed between RARP and RT in this large and unselected cohort. Nevertheless, the risk of urinary bother was lower after RT, while higher QoL was common after RARP.

Patient summary: In our study of patients treated for prostate cancer, urinary bother and overall quality of life are comparable at 1 year after surgical removal of the prostate in comparison to radiotherapy, despite substantial differences in other side effects.

Keywords: Patient-reported outcomes; Population-based study; Prostate cancer; Radical prostatectomy; Radiotherapy.

Grants and funding

P30 CA008748/CA/NCI NIH HHS/United States