Mark Douglas Tyson1, Tatsuki Koyama2, Dan Lee3, Karen E Hoffman4, Matthew J Resnick5, Xiao-Cheng Wu6, Matthew R Cooperberg7, Michael Goodman8, Sheldon Greenfield9, Ann S Hamilton10, Mia Hashibe11, Lisa E Paddock12, Antoinette Stroup12, Vivien Chen6, Ralph Conwill13, Dan McCollum13, David F Penson14, Daniel A Barocas3. 1. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Urology, Mayo Clinic Hospital, Phoenix, AZ, USA. Electronic address: tyson.mark@mayo.edu. 2. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA. 3. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN, USA. 6. School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA. 7. Department of Urology, University of California, San Francisco Medical Center, San Francisco, CA, USA. 8. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. 9. Center for Health Policy Research, University of California, Irvine, CA, USA; Department of Medicine, University of California, Irvine, CA, USA. 10. Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 11. Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. 12. Rutgers Cancer Institute of New Jersey (Drs Paddock and Stroup), Rutgers University, New Brunswick, NJ, USA. 13. Prostate Cancer Patient Advocate, Vanderbilt University School of Medicine, Nashville, TN, USA. 14. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN, USA.
Abstract
BACKGROUND: Whether prostate cancer severity modifies patient-reported functional outcomes after radical prostatectomy (RP) or external beam radiotherapy (EBRT) for localized cancer is unknown. OBJECTIVE: The purpose of this study was to determine whether differences in predicted function over time between RP and EBRT varied by risk group. DESIGN, SETTING, AND PARTICIPANTS: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based, observational study that enrolled men with localized prostate cancer in 2011-2012. Among 2117 CEASAR participants who underwent RP or EBRT, 817 had low-risk, 902 intermediate-risk, and 398 high-risk disease. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Patient-reported, disease-specific function was measured using the 26-item Expanded Prostate Index Composite (at baseline and 6, 12, and 36 mo). Predicted function was estimated using regression models and compared by disease risk. RESULTS AND LIMITATIONS: Low-risk EBRT patients reported 3-yr sexual function scores 12 points higher than those of low-risk RP patients (RP, 39 points [95% confidence interval {CI}, 37-42] vs EBRT, 52 points [95% CI, 47-56]; p<0.001). The difference in 3-yr scores for high-risk patients was not clinically significant (RP, 32 points [95% CI, 28-35] vs EBRT, 38 points [95% CI, 33-42]; p=0.03). However, when using a commonly used binary definition of sexual function (erections firm enough for intercourse), no major differences were noted between RP and EBRT at 3 yr across low-, intermediate-, and high-risk disease strata. No clinically significant interactive effects between treatment and cancer severity were observed for incontinence, bowel, irritative voiding, and hormone domains. The primary limitation is the lack of firmly established thresholds for clinically significant differences in Expanded Prostate Index Composite domain scores. CONCLUSIONS: For men with low-risk prostate cancer, EBRT was associated with higher sexual function scores at 3 yr than RP; however, for men with high-risk prostate cancer, no clinically significant difference was noted. Men with high-risk prostate cancer should be counseled that EBRT and RP carry similar sexual function outcomes at 3 yr. PATIENT SUMMARY: In this report, we studied the urinary, sexual, bowel, and hormonal functions of patients 3 yr after undergoing prostate cancer surgery or radiation. We found that for patients with high-risk disease, sexual function was similar between surgery and radiation. We conclude that high-risk patients undergoing radiation therapy should be counseled that sexual function may not be as good as low-risk patients undergoing radiation.
BACKGROUND: Whether prostate cancer severity modifies patient-reported functional outcomes after radical prostatectomy (RP) or external beam radiotherapy (EBRT) for localized cancer is unknown. OBJECTIVE: The purpose of this study was to determine whether differences in predicted function over time between RP and EBRT varied by risk group. DESIGN, SETTING, AND PARTICIPANTS: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based, observational study that enrolled men with localized prostate cancer in 2011-2012. Among 2117 CEASAR participants who underwent RP or EBRT, 817 had low-risk, 902 intermediate-risk, and 398 high-risk disease. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Patient-reported, disease-specific function was measured using the 26-item Expanded Prostate Index Composite (at baseline and 6, 12, and 36 mo). Predicted function was estimated using regression models and compared by disease risk. RESULTS AND LIMITATIONS: Low-risk EBRT patients reported 3-yr sexual function scores 12 points higher than those of low-risk RP patients (RP, 39 points [95% confidence interval {CI}, 37-42] vs EBRT, 52 points [95% CI, 47-56]; p<0.001). The difference in 3-yr scores for high-risk patients was not clinically significant (RP, 32 points [95% CI, 28-35] vs EBRT, 38 points [95% CI, 33-42]; p=0.03). However, when using a commonly used binary definition of sexual function (erections firm enough for intercourse), no major differences were noted between RP and EBRT at 3 yr across low-, intermediate-, and high-risk disease strata. No clinically significant interactive effects between treatment and cancer severity were observed for incontinence, bowel, irritative voiding, and hormone domains. The primary limitation is the lack of firmly established thresholds for clinically significant differences in Expanded Prostate Index Composite domain scores. CONCLUSIONS: For men with low-risk prostate cancer, EBRT was associated with higher sexual function scores at 3 yr than RP; however, for men with high-risk prostate cancer, no clinically significant difference was noted. Men with high-risk prostate cancer should be counseled that EBRT and RP carry similar sexual function outcomes at 3 yr. PATIENT SUMMARY: In this report, we studied the urinary, sexual, bowel, and hormonal functions of patients 3 yr after undergoing prostate cancer surgery or radiation. We found that for patients with high-risk disease, sexual function was similar between surgery and radiation. We conclude that high-risk patients undergoing radiation therapy should be counseled that sexual function may not be as good as low-risk patients undergoing radiation.
Authors: Rafael R Tourinho-Barbosa; Bradford J Wood; Andre Luis Abreu; Bruno Nahar; Toshitaka Shin; Selcuk Guven; Thomas J Polascik Journal: World J Urol Date: 2020-05-22 Impact factor: 4.226
Authors: Elizabeth J Polter; Nidhi Kohli; B R Simon Rosser; Kristine M C Talley; Christopher W Wheldon; Chris J Hoefer; Morgan Wright; Ryan Haggart; Darry Mitteldorf; Gudrun Kilian; Badrinath R Konety; Michael W Ross; William West Journal: J Sex Med Date: 2022-02-04 Impact factor: 3.802
Authors: Scott D Ramsey; Ingrid J Hall; Judith Lee Smith; Donatus U Ekwueme; Catherine R Fedorenko; Karma Kreizenbeck; Aasthaa Bansal; Ian M Thompson; David F Penson Journal: J Geriatr Oncol Date: 2020-07-29 Impact factor: 3.599
Authors: Aaron A Laviana; Zhiguo Zhao; Li-Ching Huang; Tatsuki Koyama; Ralph Conwill; Karen Hoffman; Michael Goodman; Ann S Hamilton; Xiao-Cheng Wu; Lisa E Paddock; Antoinette Stroup; Matthew R Cooperberg; Mia Hashibe; Brock B O'Neil; Sherrie H Kaplan; Sheldon Greenfield; David F Penson; Daniel A Barocas Journal: Eur Urol Date: 2020-02-22 Impact factor: 20.096
Authors: Catherine E Lovegrove; Vincenzo Ficarra; Francesco Montorsi; James N'Dow; Andrea Salonia; Suks Minhas Journal: Int J Impot Res Date: 2019-12-13 Impact factor: 2.896
Authors: Kendrick Koo; Nathan Papa; Melanie Evans; Michael Jefford; Maarten IJzerman; Victoria White; Sue M Evans; Eli Ristevski; Jon Emery; Jeremy Millar Journal: BMC Cancer Date: 2022-03-17 Impact factor: 4.430