From the AGA Journals

Prostatectomy vs. radiotherapy: 15-year functional outcomes are same



Fifteen years after treatment for localized prostate cancer, men who underwent radical prostatectomy reported no differences in urinary, bowel, or sexual function compared with men who underwent external-beam radiation, according to a report published online Jan. 30 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.

Source: American Gastroenterological Association (

"Since the median life expectancy after treatment for prostate cancer is 13.8 years, a careful evaluation of long-term functional outcomes is critical to an understanding of the comprehensive experience of men living with a diagnosis of prostate cancer," said 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.

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 ED was "nearly universal," affecting 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 [doi10.1056/NEJMoa1209978]).

This study was funded by the National Cancer Institute. Dr. Resnick was supported by the VA National Quality Scholars Program and the T. J. Martell Foundation. Dr. Resnick reported ties to Dendreon and Bayer Healthcare, and his associates reported ties to Ferring and Johnson & Johnson.

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