Peter Chang1, Meredith M Regan2, Montserrat Ferrer3, Ferran Guedea4, Dattatraya Patil5, John T Wei6, Larry A Hembroff7, Jeff M Michalski8, Chris S Saigal9, Mark S Litwin10, Daniel A Hamstra11, Irving D Kaplan12, Jay P Ciezki13, Eric A Klein14, Adam S Kibel15, Howard M Sandler16, Rodney L Dunn6, Catrina M Crociani17, Martin G Sanda5. 1. Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. Electronic address: pchang@bidmc.harvard.edu. 2. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. 3. Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain. 4. Department of Radiation Oncology, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain. 5. Department of Urology, Emory University School of Medicine, Atlanta, Georgia. 6. Department of Urology, University of Michigan, Ann Arbor, Michigan. 7. Office for Survey Research, Institute for Public Policy and Social Research, Michigan State University, East Lansing, Michigan. 8. Department of Radiation Oncology, Washington University, St. Louis, Missouri. 9. Department of Urology, UCLA Center for Health Sciences, Los Angeles, California. 10. Department of Urology, UCLA Center for Health Sciences, Los Angeles, California; Department of Health Policy and Management, UCLA Center for Health Sciences, Los Angeles, California. 11. Texas Center for Proton Therapy, Irving, Texas. 12. Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. 13. Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio. 14. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. 15. Division of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 16. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California. 17. Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Abstract
PURPOSE: Harms of prostate cancer treatment on urinary health related quality of life have been thoroughly studied. In this study we evaluated not only the harms but also the potential benefits of prostate cancer treatment in relieving the pretreatment urinary symptom burden. MATERIALS AND METHODS: In American (1,021) and Spanish (539) multicenter prospective cohorts of men with localized prostate cancer we evaluated the effects of radical prostatectomy, external radiotherapy or brachytherapy in relieving pretreatment urinary symptoms and in inducing urinary symptoms de novo, measured by changes in urinary medication use and patient reported urinary bother. RESULTS: Urinary symptom burden improved in 23% and worsened in 28% of subjects after prostate cancer treatment in the American cohort. Urinary medication use rates before treatment and 2 years after treatment were 15% and 6% with radical prostatectomy, 22% and 26% with external radiotherapy, and 19% and 46% with brachytherapy, respectively. Pretreatment urinary medication use (OR 1.4, 95% CI 1.0-2.0, p = 0.04) and pretreatment moderate lower urinary tract symptoms (OR 2.8, 95% CI 2.2-3.6) predicted prostate cancer treatment associated relief of baseline urinary symptom burden. Subjects with pretreatment lower urinary tract symptoms who underwent radical prostatectomy experienced the greatest relief of pretreatment symptoms (OR 4.3, 95% CI 3.0-6.1), despite the development of deleterious de novo urinary incontinence in some men. The magnitude of pretreatment urinary symptom burden and beneficial effect of cancer treatment on those symptoms were verified in the Spanish cohort. CONCLUSIONS: Men with pretreatment lower urinary tract symptoms may experience benefit rather than harm in overall urinary outcome from primary prostate cancer treatment. Practitioners should consider the full spectrum of urinary symptom burden evident before prostate cancer treatment in treatment decisions.
PURPOSE:Harms of prostate cancer treatment on urinary health related quality of life have been thoroughly studied. In this study we evaluated not only the harms but also the potential benefits of prostate cancer treatment in relieving the pretreatment urinary symptom burden. MATERIALS AND METHODS: In American (1,021) and Spanish (539) multicenter prospective cohorts of men with localized prostate cancer we evaluated the effects of radical prostatectomy, external radiotherapy or brachytherapy in relieving pretreatment urinary symptoms and in inducing urinary symptoms de novo, measured by changes in urinary medication use and patient reported urinary bother. RESULTS: Urinary symptom burden improved in 23% and worsened in 28% of subjects after prostate cancer treatment in the American cohort. Urinary medication use rates before treatment and 2 years after treatment were 15% and 6% with radical prostatectomy, 22% and 26% with external radiotherapy, and 19% and 46% with brachytherapy, respectively. Pretreatment urinary medication use (OR 1.4, 95% CI 1.0-2.0, p = 0.04) and pretreatment moderate lower urinary tract symptoms (OR 2.8, 95% CI 2.2-3.6) predicted prostate cancer treatment associated relief of baseline urinary symptom burden. Subjects with pretreatment lower urinary tract symptoms who underwent radical prostatectomy experienced the greatest relief of pretreatment symptoms (OR 4.3, 95% CI 3.0-6.1), despite the development of deleterious de novo urinary incontinence in some men. The magnitude of pretreatment urinary symptom burden and beneficial effect of cancer treatment on those symptoms were verified in the Spanish cohort. CONCLUSIONS:Men with pretreatment lower urinary tract symptoms may experience benefit rather than harm in overall urinary outcome from primary prostate cancer treatment. Practitioners should consider the full spectrum of urinary symptom burden evident before prostate cancer treatment in treatment decisions.
Authors: P P Sagnier; C J Girman; M Garraway; Y Kumamoto; M M Lieber; F Richard; G MacFarlane; H A Guess; S J Jacobsen; T Tsukamoto; P Boyle Journal: Eur Urol Date: 1996 Impact factor: 20.096
Authors: Gregory S Merrick; Wayne M Butler; Kent E Wallner; Robert W Galbreath; Jonathan H Lief Journal: Int J Radiat Oncol Biol Phys Date: 2003-06-01 Impact factor: 7.038
Authors: Gunnar Steineck; Fred Helgesen; Jan Adolfsson; Paul W Dickman; Jan-Erik Johansson; Bo Johan Norlén; Lars Holmberg Journal: N Engl J Med Date: 2002-09-12 Impact factor: 91.245
Authors: Tracy M Downs; Natalia Sadetsky; David J Pasta; Gary D Grossfeld; Christopher J Kane; Shilpa S Mehta; Peter R Carroll; Deborah P Lubeck Journal: J Urol Date: 2003-11 Impact factor: 7.450
Authors: David P Smith; Madeleine T King; Sam Egger; Martin P Berry; Phillip D Stricker; Paul Cozzi; Jeanette Ward; Dianne L O'Connell; Bruce K Armstrong Journal: BMJ Date: 2009-11-27
Authors: Lin Yang; Adam S Kibel; Graham A Colditz; Ratna Pakpahan; Kellie R Imm; Sonya Izadi; Robert L Grubb; Kathleen Y Wolin; Siobhan Sutcliffe Journal: J Urol Date: 2017-07-18 Impact factor: 7.450
Authors: Ronald C Chen; Ramsankar Basak; Anne-Marie Meyer; Tzy-Mey Kuo; William R Carpenter; Robert P Agans; James R Broughman; Bryce B Reeve; Matthew E Nielsen; Deborah S Usinger; Kiayni C Spearman; Sarah Walden; Dianne Kaleel; Mary Anderson; Til Stürmer; Paul A Godley Journal: JAMA Date: 2017-03-21 Impact factor: 56.272
Authors: Kevin Li; Imon Banerjee; Christopher J Magnani; Douglas W Blayney; James D Brooks; Tina Hernandez-Boussard Journal: Res Rep Urol Date: 2020-01-23