© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 19, 1582-1592,
October 4, 2000
© 2000 Oxford University Press
Health Outcomes After Prostatectomy or Radiotherapy for Prostate Cancer: Results From the Prostate Cancer Outcomes Study
Affiliations of authors: A. L. Potosky, J. Legler, L. C. Harlan, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; P. C. Albertsen, Division of Urology, University of Connecticut Health Center, Farmington; J. L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; F. D. Gilliland, New Mexico Tumor Registry, Albuquerque, and Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles; A. S. Hamilton, Department of Preventive Medicine, University of Southern California Keck School of Medicine; J. W. Eley, Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta; R. A. Stephenson, Division of Urology, University of Utah Department of Medicine, Salt Lake City.
Correspondence to: Arnold L. Potosky, Ph.D., National Institutes of Health, EPN, Rm. 4005, 6130 Executive Blvd., MSC 7344, Bethesda, MD 20892-7344 (overnight mail: Rockville, MD 20852) (e-mail: potosky{at}nih.gov).
Background: Radical prostatectomy and external beam radiotherapy are the two major therapeutic options for treating clinically localized prostate cancer. Because survival is often favorable regardless of therapy, treatment decisions may depend on other therapy-specific health outcomes. In this study, we compared the effects of two treatments on urinary, bowel, and sexual functions and on general health-related quality-of-life outcomes over a 2-year period following initial treatment. Methods: A diverse cohort of patients aged 55–74 years who were newly diagnosed with clinically localized prostate cancer and received either radical prostatectomy (n = 1156) or external beam radiotherapy (n = 435) were included in this study. A propensity score was used to balance the two treatment groups because they differed in some baseline characteristics. This score was used in multivariable cross-sectional and longitudinal regression analyses comparing the treatment groups. All statistical tests were two-sided. Results: Almost 2 years after treatment, men receiving radical prostatectomy were more likely than men receiving radiotherapy to be incontinent (9.6% versus 3.5%; P<.001) and to have higher rates of impotence (79.6% versus 61.5%; P<.001), although large, statistically significant declines in sexual function were observed in both treatment groups. In contrast, men receiving radiotherapy reported greater declines in bowel function than did men receiving radical prostatectomy. All of these differences remained after adjustments for propensity score. The treatment groups were similar in terms of general health-related quality of life. Conclusions: There are important differences in urinary, bowel, and sexual functions over 2 years after different treatments for clinically localized prostate cancer. In contrast to previous reports, these outcome differences reflect treatment delivered to a heterogeneous group of patients in diverse health care settings. These results provide comprehensive and representative information about long-term treatment complications to help guide and inform patients and clinicians about prostate cancer treatment decisions.
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