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Question clinique
Are functional outcomes different for men with localized prostate cancer depending on treatment choice?
L’Essentiel
In men with localized prostate cancer, most functional outcome differences related to treatment options attenuated by 5 years. However, men who underwent prostatectomy reported worse urinary incontinence and sexual function through 5 years than men who chose other treatment options. Survival rates within the 2 groups of favorable-risk and unfavorable-risk prostate cancer did not differ based on treatment option. 2b
Référence
Plan de l'etude: Cohort (prospective)
Financement: Government
Cadre: Population-based
Sommaire
These investigators analyzed data from a prospective cohort study of 2005 men with localized prostate cancer. Using standard diagnostic criteria, participants were further classified as having either favorable-risk (n = 1386) or unfavorable-risk (n = 619) cancer. Treatment, including active surveillance, nerve-sparing prostatectomy, external beam radiation therapy (EBRT) with or without androgen deprivation therapy (ADT), or low-dose-rate brachytherapy (LDRB), was determined by patient report at 1 year. Patient-reported outcomes, using previously validated assessment tools, had a 77% response rate at 5 years. Survival outcomes occurred through review of appropriate medical records and cancer surveillance registries. In men with favorable-risk prostate cancer, prostatectomy was associated with worse urinary incontinence at 5 years and sexual function at 3 years compared with active surveillance. LDRB was associated with worse urinary irritative function, sexual function, and bowel function at 1 year compared with active surveillance, but functional differences no longer remained after 5 years. In men with unfavorable-risk disease, EBRT with ADT was associated with lower bowel function at 1 year but better sexual function at 5 years and less urinary incontinence through 5 years than prostatectomy. Survival rates within each risk group were similar regardless of treatment option.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Commentaires
Biased title
This is a five year study prostate cancer outcomes are not apparent within that. timeframe.