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BJU Int. 2016 Jun;117(6B):E36-45. doi: 10.1111/bju.13179. Epub 2015 Jun 23.

Population-based study of long-term functional outcomes after prostate cancer treatment.

Author information

1
Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
2
Department of Urology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
3
Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden.
4
New York University and Manhattan Veterans Affairs Medical Center, New York, NY, USA.
5
Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
6
Department of Oncology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
7
Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden.
8
Department of Urology, Ryhov County Hospital, Jönköping, Sweden.
9
Department of Surgical Sciences, University Hospital of Uppsala, Uppsala, Sweden.
10
Department of Nursing, Umeå University, Umeå, Sweden.

Abstract

OBJECTIVE:

To evaluate long-term urinary, sexual and bowel functional outcomes after prostate cancer treatment at a median (interquartile range) follow-up of 12 (11-13) years.

PATIENTS AND METHODS:

In this nationwide, population-based study, we identified 6 003 men diagnosed with localized prostate cancer (clinical local stage T1-2, any Gleason score, prostate-specific antigen <20 ng/mL, NX or N0, MX or M0) between 1997 and 2002 from the National Prostate Cancer Register, Sweden. The men were aged ≤70 years at diagnosis. A control group of 1 000 men without prostate cancer were also selected, matched for age and county of residence. Functional outcomes were evaluated with a validated self-reported questionnaire.

RESULTS:

Responses were obtained from 3 937/6 003 cases (66%) and 459/1 000 (46%) controls. At 12 years after diagnosis and at a median age of 75 years, the proportion of cases with adverse symptoms was 87% for erectile dysfunction/sexual inactivity, 20% for urinary incontinence and 14% for bowel disturbances. The corresponding proportions for controls were 62, 6 and 7%, respectively. Men with prostate cancer, except those on surveillance, had an increased risk of erectile dysfunction compared with the men in the control group. Radical prostatectomy was associated with an increased risk of urinary incontinence (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.36-2.62) and radiotherapy increased the risk of bowel dysfunction (OR 2.46, 95% CI 1.73-3.49) compared with men in the control group. Multi-modal treatment, in particular treatment including androgen deprivation therapy (ADT), was associated with the highest risk of adverse effects; for instance, radical prostatectomy followed by radiotherapy and ADT was associated with an OR of 3.74 (95% CI 1.76-7.95) for erectile dysfunction and an OR of 3.22 (95% CI 1.93-5.37) for urinary incontinence.

CONCLUSION:

The proportion of men who experienced a long-term impact on functional outcomes after prostate cancer treatment was substantial.

KEYWORDS:

erectile dysfunction; prostate cancer; prostatic neoplasms/therapy; quality of life; urinary incontinence

PMID:
25959859
PMCID:
PMC4637260
DOI:
10.1111/bju.13179
[Indexed for MEDLINE]
Free PMC Article

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