The purpose of this analysis was to compare long-term urinary, bowel, and sexual function after radical prostatectomy or external-beam radiation therapy.
The Prostate Cancer Outcomes Study (PCOS) enrolled 3533 men in whom prostate cancer had been diagnosed in 1994 or 1995. The current cohort comprised 1655 men in whom localized prostate cancer had been diagnosed between the ages of 55 and 74 years and who had undergone either surgery (1164 men) or radiotherapy (491 men). Functional status was assessed at baseline and at 2, 5, and 15 years after diagnosis. We used multivariable propensity scoring to compare functional outcomes according to treatment.
Patients undergoing prostatectomy were more likely to have urinary incontinence than were those undergoing radiotherapy at 2 years (odds ratio, 6.22; 95% confidence interval [CI], 1.92 to 20.29) and 5 years (odds ratio, 5.10; 95% CI, 2.29 to 11.36). However, no significant between-group difference in the odds of urinary incontinence was noted at 15 years. Similarly, although patients undergoing prostatectomy were more likely to have erectile dysfunction at 2 years (odds ratio, 3.46; 95% CI, 1.93 to 6.17) and 5 years (odds ratio, 1.96; 95% CI, 1.05 to 3.63), no significant between-group difference was noted at 15 years. Patients undergoing prostatectomy were less likely to have bowel urgency at 2 years (odds ratio, 0.39; 95% CI, 0.22 to 0.68) and 5 years (odds ratio, 0.47; 95% CI, 0.26 to 0.84), again with no significant between-group difference in the odds of bowel urgency at 15 years.
At 15 years, no significant relative differences in disease-specific functional outcomes were observed among men undergoing prostatectomy or radiotherapy. Nonetheless, men treated for localized prostate cancer commonly had declines in all functional domains during 15 years of follow-up. (Funded by the National Cancer Institute.).
"Thus it is important to be able to forecast the pattern of sexual function level should one undergo a prostatectomy. Crucially, sexual function trajectories after prostatectomy are known to follow a recovery curve, both from past studies Potosky et al. (2004) (at least up to 5 years post-treatment, see Resnick et al., 2013), and from our dataset. To illustrate, in Figure 1a "
[Show abstract][Hide abstract] ABSTRACT: We propose a Bayesian model that predicts recovery curves based on
information available before the disruptive event. A recovery curve of interest
is the quantified sexual function of prostate cancer patients after
prostatectomy surgery. We illustrate the utility of our model as a
pre-treatment medical decision aid, producing personalized predictions that are
both interpretable and accurate. We uncover covariate relationships that agree
with and supplement that in existing medical literature.
"This duration was chosen as it represents the time frame with the steepest slope of recovery from post-surgery incontinence (e.g. Resnick et al., 2013). Participants were mailed study materials and separate pre-stamped return envelopes for patients and partners. "
"Second, when treatment is given, it is applied in a radical whole-gland manner (using surgery or radiotherapy) which causes collateral tissue damage and side effects. In summary, erectile dysfunction, urinary incontinence and bowel toxicity occur in about 40–95%, 10–20% and 5–35% of men undergoing radical therapy, respectively . As a result, one strategy that has been proposed to mitigate the harms of the current pathway is focal therapy. "
[Show abstract][Hide abstract] ABSTRACT: Introduction
Focal therapy may reduce the toxicity of current radical treatments while maintaining the oncological benefit. Irreversible Electroporation (IRE) has been proposed to be tissue selective and so might have favourable characteristics compared to currently used prostate ablative technologies. The aim of this trial is to determine the adverse events, genito-urinary side effects and early histological outcomes of focal IRE in men with localised prostate cancer.
Single centre prospective development (stage 2a) study following the IDEAL recommendations for evaluating new surgical procedures. Twenty men who have MRI-visible disease localised in the anterior part of the prostate will be recruited. The sample size permits a precision estimate around key functional outcomes. Inclusion criteria include PSA </= 15ng/ml, Gleason score </= 4+3, stage T2N0M0 and absence of clinically significant disease outside the treatment area. Treatment delivery will be changed in an adaptive iterative manner so as to allow optimisation of the IRE protocol. After focal IRE, men will be followed during 12 months using validated patient reported outcome measures (IPSS, IIEF-15, UCLA-EPIC, EQ-5D, FACT-P, MAX-PC). Early disease control will be evaluated by mpMRI and targeted transperineal biopsy of the treated area at 6 months.
The NEAT trial will assess the early functional and disease control outcome of focal IRE using an adaptive design. Our protocol can provide guidance for designing an adaptive trial to assess new surgical technologies in the challenging landscape of health technology assessment in prostate cancer treatment.
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