Comparative Effectiveness Research in Localized Prostate Cancer : A 10-Year Follow-up Cohort Study
Garin, Olatz (Universitat Pompeu Fabra)
Suárez, J.F. (Hospital Universitari de Bellvitge)
Guedea, F. (Institut Català d'Oncologia)
Pont, À. (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Pardo Cladellas, Yolanda (Universitat Autònoma de Barcelona)
Goñi, Alai (Institutu Onkologikoa)
Mariño, Alfonso (Servicio de Oncología Radioterápica. Centro Oncológico de Galicia)
Hervás, A. (Hospital Universitario Ramón y Cajal (Madrid))
Herruzo, I. (Hospital Regional Universitario Carlos Haya (Málaga))
Cabrera, Patricia (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Sancho-Pardo, Gemma (Institut d'Investigació Biomèdica Sant Pau)
Ponce de León Roca, Javier (Institut d'Investigació Biomèdica Sant Pau)
Macías Hernández, Víctor (Hospital Universitari i Politècnic La Fe (València))
Gutierrez, Cristina (Institut Català d'Oncologia)
Castells, Manel (Hospital Universitari de Bellvitge)
Ferrer, M. (Universitat Autònoma de Barcelona)

Date:	2021
Abstract:	Purpose: Long-term comparative effectiveness research on localized prostate cancer treatments is scarce, and evidence is lacking especially for brachytherapy. The aim of this study was to assess the long-term impact of the side effects of radical prostatectomy, brachytherapy, and external radiation therapy on patients with localized prostate cancer at 10 years, using propensity score analyses. Methods and Materials: This was a prospective observational study of a cohort of men who received a diagnosis of clinically localized prostate cancer (clinical stage T1 or T2, low and intermediate risk group) and were treated with radical prostatectomy (n = 139), brachytherapy (n = 317), or external radiation therapy (n = 194). Treatment decisions were jointly made by patients and physicians. Patient-reported outcome (PRO) evaluation included the Expanded Prostate Cancer Index Composite and Short Form-36, administered centrally by telephone interviews before and annually after treatment. The Expanded Prostate Cancer Index Composite covers urinary, bowel, sexual, and hormonal domains. To assess PRO changes over time, while accounting for correlation among repeated measures, generalized estimating equation models adjusted by propensity scores were constructed. Results: The PRO completion rate at 10 years was 85. 8%. Generalized estimating equation models showed that the pattern of radical prostatectomy side effects, with substantial urinary incontinence and sexual dysfunction, remained until 10 years after treatment (standard deviation [SD], -1. 1 and -1. 3, respectively). Brachytherapy produced late deterioration in urinary continence (SD, -0. 4) and sexual function (SD, -0. 9) that appeared midterm, but the differences from radical prostatectomy remained statistically significant at 10 years (P <. 001 after adjusting by propensity score). External radiation therapy showed similar results to brachytherapy, but with bowel bother (SD, -0. 3). Conclusions: Although late deterioration in radiation therapy groups attenuated differences from radical prostatectomy, relevant PRO differences still remained after 10 years. Our findings support that brachytherapy is the treatment option that causes the least impact on PROs; it is therefore an alternative to be considered when making evidence-based decisions on localized prostate cancer treatment.
Grants:	Instituto de Salud Carlos III PI02/0668 Instituto de Salud Carlos III PI08/90090 Instituto de Salud Carlos III PI13/00412 Agència de Gestió d'Ajuts Universitaris i de Recerca 086/24/2000 Agència de Gestió d'Ajuts Universitaris i de Recerca 2017SGR452 Ministerio de Ciencia e Innovación PTA2011-04891
Note:	Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER).
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Comparative effectiveness researches ; Evidence- based decisions ; Expanded prostate cancer index composites ; Generalized estimating equations ; Localized prostate cancer ; Methods and materials ; Patient-reported outcomes ; Radical prostatectomy ; Brachytherapy ; Cohort Studies ; Comparative Effectiveness Research ; Follow-Up Studies ; Humans ; Male ; Patient Reported Outcome Measures ; Prospective Studies ; Prostatic Neoplasms ; Quality of Life
Published in:	International Journal of Radiation Oncology Biology Physics, Vol. 110 Núm. 3 (january 2021) , p. 718-726, ISSN 1879-355X

DOI: 10.1016/j.ijrobp.2020.12.032
PMID: 33388360

9 p, 1.6 MB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles