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Population-based study of long-term functional outcomes after prostate cancer treatment
Mem Sloan Kettering Canc Ctr, Dept Surg, Urol Serv, New York, NY 10021 USA.;Univ Gothenburg, Sahlgrenska Acad, Dept Urol, Gothenburg, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
NYU, New York, NY USA.;Manhattan Vet Affairs Med Ctr, New York, NY USA..
Umea Univ, Oncol, Dept Radiat Sci, Umea, Sweden..
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2016 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 117, no 6B, E36-E45 p.Article in journal (Refereed) PublishedText
Abstract [en]

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. Multimodal 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.

Place, publisher, year, edition, pages
2016. Vol. 117, no 6B, E36-E45 p.
Keyword [en]
prostate cancer, erectile dysfunction, urinary incontinence, prostatic neoplasms/therapy, quality of life
National Category
Urology and Nephrology Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-299050DOI: 10.1111/bju.13179ISI: 000377589100004PubMedID: 25959859OAI: oai:DiVA.org:uu-299050DiVA: diva2:948792
Available from: 2016-07-13 Created: 2016-07-13 Last updated: 2016-07-13Bibliographically approved

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