Major Finding: Radical retropubic prostatectomy (RRP) was associated with significantly more urinary incontinence and sexual dysfunction than were other treatments.
Data Source: A 3-year follow-up from a Spanish trial comparing health-related quality of life outcomes after primary radical RRP, external beam radiotherapy (EBRT), and interstitial brachytherapy in 435 patients with localized (T1/2) prostate cancer not given hormonal treatment.
Disclosures: The Spanish National Health System funded the study. Dr. Guedea had no conflicts of interest.
BARCELONA – The 3-year results of a nonrandomized trial from Spain reveal different patterns of adverse events after three leading treatments for localized prostate cancer.
Radical retropubic prostatectomy (RRP) was associated with significantly more urinary incontinence and sexual dysfunction than were external beam radiotherapy (EBRT) or brachytherapy, according to charts presented at the meeting.
Brachytherapy, however, was associated with far more irritative and obstructive urinary symptoms than were surgery or EBRT).
The trial was conducted in 11 hospitals throughout Spain, and originally enrolled 435 men with stage T1 and T2 prostate cancer who had received no prior surgical resection or hormonal treatment. The aim of the trial was to compare the health-related quality of life (HRQoL) impact of the three treatments.
Treatment decisions were made jointly by physicians and patients; the analysis covered 123 men who had RRP, 127 who had EBRT, and 123 who had brachytherapy.
HRQoL was assessed using validated questionnaires before and at 1, 3, 6, 12, 24, and 36 months after treatment. The questionnairesuincluded the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Association Symptom Index.
This study is important because it takes into account the patients' quality of life before they had any treatment, Dr. Ferran Guedea said at a scientific press briefing. Previously published results showed that despite partial recovery from immediate deterioration in HRQoL, relevant differences persisted with 2 years' follow-up (Int. J. Radiat. Oncol. Biol. Phys. 2008; 72:421-32).
The 3-year results also show that in each treatment group, HRQoL deteriorated immediately after treatment, but then rose to varying degrees, said Dr. Guedea, a radiation oncologist at the Catalan Institute of Oncology, L'Hospitalet de Llobregat, near Barcelona.
SF-36 Physical Component scores decreased most dramatically after prostatectomy compared with either radiotherapy technique, but rose in the first 6 months after the procedure before gradually deteriorating over the 3-year follow-up.
EBRT produced lower scores than those for brachytherapy, and these gradually worsened during long-term follow-up, such that they were lower at 3 years than were scores in patients who had undergone surgery.
“RRP caused considerable urinary incontinence and sexual dysfunction,” Dr. Guedea observed. He added: “Brachytherapy and EBRT caused moderate urinary irritative-obstructive urinary symptoms and moderate adverse effects on sexual function, and finally, EBRT had very moderate bowel-related adverse events.”