Long-term complications and health-related quality of life outcomes after radical prostatectomy with or without subsequent radiation treatment for prostate cancer

Avi Baskin; Janet E Cowan; Avery Braun; Peter E Lonergan; Osama Mohamad; Samuel L Washington 3rd; Shoujun Zhao; Jeanette M Broering; Matthew R Cooperberg; Benjamin N Breyer; Peter R Carroll

doi:10.1016/j.urolonc.2023.06.003

Long-term complications and health-related quality of life outcomes after radical prostatectomy with or without subsequent radiation treatment for prostate cancer

Urol Oncol. 2023 Oct;41(10):429.e9-429.e14. doi: 10.1016/j.urolonc.2023.06.003. Epub 2023 Jul 3.

Authors

Affiliations

¹ Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
² Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA. Electronic address: Avery.Braun@ucsf.edu.
³ Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA; Department of Urology, St. James's Hospital, Dublin, Ireland; Department of Surgery, Trinity College, Dublin, Ireland.
⁴ Department of Radiation Oncology, University of California, San Francisco, CA.
⁵ Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA.
⁶ Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA; Department of Surgery, University of California, San Francisco, CA.

PMID: 37407420
DOI: 10.1016/j.urolonc.2023.06.003

Abstract

Background: To report objective long-term complications and health related quality of life (HRQOL) outcomes after radical prostatectomy (RP) with and without radiation therapy (RT) for prostate cancer (CaP).

Methods: We analyzed patients diagnosed with CaP who underwent RP from the UCSF Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry between 1995 and 2020. Cox proportional hazards were used to assess risk of postoperative complications which included cystitis, gastrointestinal (GI) toxicity, incontinence requiring a surgical procedure, ureteral injury and urinary stricture. Repeated measures mixed models were used to assess the effects of radiation and complications on patient-reported urinary, bowel, and sexual function after surgery.

Results: Of 6,258 men who underwent RP, cumulative incidence of EBRT was 9.1% at 5 years after surgery. Patients who received postoperative radiation were at increased risk for onset of cystitis (HR 5.60, 95% CI 3.40-9.22, P < 0.01). Receipt of RT was not associated with other complications. In repeated measures analysis, postoperative RT was associated with worsening general health scores, adjusting for complications of incontinence, urinary stricture, GI toxicity or ureteral injury, independent of whether patients had those complications.

Conclusions: RT after RP was associated with an increase in the risk of cystitis and worse general health in the long term. Other complications and HRQOL outcomes did not demonstrate differences by whether patients had RT or not. While post-operative RT is the only curative option for CaP after RP, patients and providers should be aware of the increased risks when making treatment decisions.

Keywords: Complications; Prostate cancer; Quality of life; Radiotherapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Constriction, Pathologic / etiology
Cystitis*
Humans
Male
Prostatectomy / adverse effects
Prostatectomy / methods
Prostatic Neoplasms* / etiology
Prostatic Neoplasms* / radiotherapy
Prostatic Neoplasms* / surgery
Quality of Life
Urinary Incontinence* / etiology