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Am Fam Physician. 2013;88(9):609

Clinical Question

What are the long-term outcomes after surgery or radiation therapy for localized prostate cancer?

Bottom Line

Patients undergoing surgery had worse urinary and sexual outcomes, whereas those undergoing external beam radiation therapy (EBRT) had worse bowel symptoms. Watchful waiting (“active surveillance”) was not the subject of this study, but given the problems associated with therapy, active surveillance is looking better and better for patients who have localized prostate cancer. (Level of Evidence = 2b)

Synopsis

The researchers used data from men between 55 and 74 years of age who had been given a diagnosis of localized prostate cancer in the mid 1990s, and who had been followed up prospectively for 15 years. All underwent prostatectomy (n = 1,164) or EBRT (n = 491) as part of the long-term Prostate Cancer Outcomes Study. The median age of men was 64 years in the surgery group and 69 years in the EBRT group. Most had a Gleason score between 2 and 4 (63%) or between 5 and 7 (19%). Men were contacted at one, two, five, and 15 years to be asked about clinical symptoms and disease-specific quality of life. At each time point, urinary symptoms and sexual functions were worse in the surgery group, whereas bowel symptoms (urgency, bothered by frequent bowel movements, or pain) were worse in the radiotherapy group. Erection insufficient for intercourse was common in both groups: 78.8% of those undergoing surgery and 61% undergoing EBRT after two years; 76% and 72%, respectively, after five years. Urinary and sexual function was lowest in surgery patients approximately six to 12 months after treatment. Although urinary and sexual function improved somewhat over the next year or two, it never returned to baseline. The same was true, although to a less dramatic extent, for bowel function. Note that after 15 years, there were no longer any significant differences, although this could be because of a diminished sample size (a lot of patients were not around 15 years later).

Study Information

Study design: Cohort (prospective)

Setting: Outpatient (any)

Funding source: Government

Reference: ResnickMJKoyamaTFanKHet alLong-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013; 368( 5): 436– 445.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

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A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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