Prostate Procedures Give Elderly Men Similar 15-Year Results

Abstract

Fifteen years after treatment for localized prostate cancer, men who underwent radical prostatectomy at ages 55-74 reported no difference in urinary, bowel, or sexual function compared with men who underwent external-beam radiation, according to a report in the New England Journal of Medicine.Using data from the Prostate Cancer Outcomes Study (PCOS), a population-based cohort of men across the United States diagnosed as having prostate cancer in the mid-1990s, researchers tracked the long-term disease-specific outcomes of 1,655 men who underwent radical prostatectomy (70.3% of patients) or radiotherapy (29.7%), with or without androgen-deprivation therapy.The median life expectancy after treatment for prostate cancer is 13.8 years, Dr. Matthew J. Resnick of the department of urologic surgery and the Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, Tenn., and his associates pointed out.Even though men who had radical prostatectomy were more likely to be bothered by such difficulties as urinary incontinence, bowel urgency, and erectile dysfunction at 2 years and 5 years after treatment, those differences disappeared by the 15-year mark. At that time, the prevalence of erectile dysfunction affected 87% of men in the prostatectomy group and 94% of those in the radiotherapy group. Yet only 43% and 38%, respectively, reported that this bothered them.“Long-term follow-up reveals consistent functional declines after 5 years. It remains unknown whether this continued decline is due to prostate cancer and its treatment, the normal aging process, or a combination of factors,” the investigators said (N. Engl. J. Med. 2013;368:436-45).Dr. Resnick reported ties to Dendreon and Bayer Healthcare, and his associates reported ties to Ferring and Johnson & Johnson. Fifteen years after treatment for localized prostate cancer, men who underwent radical prostatectomy at ages 55-74 reported no difference in urinary, bowel, or sexual function compared with men who underwent external-beam radiation, according to a report in the New England Journal of Medicine. Using data from the Prostate Cancer Outcomes Study (PCOS), a population-based cohort of men across the United States diagnosed as having prostate cancer in the mid-1990s, researchers tracked the long-term disease-specific outcomes of 1,655 men who underwent radical prostatectomy (70.3% of patients) or radiotherapy (29.7%), with or without androgen-deprivation therapy. The median life expectancy after treatment for prostate cancer is 13.8 years, Dr. Matthew J. Resnick of the department of urologic surgery and the Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, Tenn., and his associates pointed out. Even though men who had radical prostatectomy were more likely to be bothered by such difficulties as urinary incontinence, bowel urgency, and erectile dysfunction at 2 years and 5 years after treatment, those differences disappeared by the 15-year mark. At that time, the prevalence of erectile dysfunction affected 87% of men in the prostatectomy group and 94% of those in the radiotherapy group. Yet only 43% and 38%, respectively, reported that this bothered them. “Long-term follow-up reveals consistent functional declines after 5 years. It remains unknown whether this continued decline is due to prostate cancer and its treatment, the normal aging process, or a combination of factors,” the investigators said (N. Engl. J. Med. 2013;368:436-45). Dr. Resnick reported ties to Dendreon and Bayer Healthcare, and his associates reported ties to Ferring and Johnson & Johnson.