Acute, Subchronic, and Chronic Complications of Radical Prostatectomy Versus Radiotherapy With Hormone Therapy in Older Adults With High-Risk Prostate Adenocarcinoma

Szu-Yuan Wu; Le Duc Huy; Chih Jung Liao; Chung-Chien Huang

doi:10.3389/fonc.2022.875036

Acute, Subchronic, and Chronic Complications of Radical Prostatectomy Versus Radiotherapy With Hormone Therapy in Older Adults With High-Risk Prostate Adenocarcinoma

Front Oncol. 2022 May 2:12:875036. doi: 10.3389/fonc.2022.875036. eCollection 2022.

Authors

Szu-Yuan Wu^{1

2

3

4

5

6

7}, Le Duc Huy^{8

9}, Chih Jung Liao¹⁰, Chung-Chien Huang^{11

12

13

14}

Affiliations

¹ Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
² Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
³ Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
⁴ Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
⁵ Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
⁶ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan.
⁷ Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁸ Master Program in School of Health Care Administration, Department of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
⁹ Health Management Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
¹⁰ Department of Medical Imaging, Taipei Medical University-Shuang-ho Hospital, New Taipei City, Taiwan.
¹¹ International PhD Program in Biotech and Healthcare Management, School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
¹² Department of Medical Quality, Taipei Municipal Wan Fang Hospital - Managed by Taipei Medical University, Taipei, Taiwan.
¹³ Department of Long-Term Care and School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.
¹⁴ Department and School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.

Abstract

Purpose: To compare acute, subchronic, and chronic complications between older patients with high-risk localized prostate cancer (HR-LPC) receiving radical prostatectomy (RP) and high-dose intensity-modulated radiotherapy (IMRT) combined with long-term hormone therapy (HT).

Patients and methods: We recruited older patients (≥80 years) with HR-LPC from the Taiwan Cancer Registry database. After propensity score matching, logistic regression analysis was used to compare the acute, subchronic, and chronic complication rates between patients who underwent RP (the RP group) and high-dose IMRT combined with long-term HT (the IMRT+HT group).

Results: Benign prostatic hyperplasia (BPH) symptoms and urinary incontinence (UI) were the most common complications over 5 years (BPH symptoms: RP, 17.69%; IMRT+HT, 29.58%; UI: RP, 10.47%; IMRT+HT, 5.50%). Compared with the RP group, the IMRT+HT group had higher odds of BPH symptoms and lower odds of UI and hernia after the 5-year follow-up period. The impotence rates were significantly higher in the IMRT+HT group than in the RP group at 3 months and 1 year after treatment and became nonsignificant after 2 years. At 5 years after treatment, the IMRT+HT group had lower risks of UI (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.28-0.88) and hernia (aOR, 0.21; 95% CI, 0.11-0.82) and a higher risk of BPH symptoms (aOR, 4.15; 95% CI, 2.82-7.37) than the RP group.

Conclusion: IMRT+HT was associated with lower UI and hernia risks than RP. By contrast, RP was associated with fewer complications of BPH over the follow-up period and less impotence during the first year after treatment. Our findings provide important and valuable references for shared decision-making for optimal therapy selection among older men with HR-LPC.

Keywords: complications; high-risk localized prostate cancer; intensity-modulated radiotherapy; old age; radical prostatectomy.