Twenty-year Patient-reported Outcomes After Surgery, Radiotherapy, or Brachytherapy for Localized Prostate Cancer
Zamora, Víctor (Hospital del Mar (Barcelona, Catalunya))
Garin, Olatz (Universitat Pompeu Fabra)
Suárez, José Francisco (Hospital Universitari de Bellvitge)
Guedea, Ferran (Institut Català d'Oncologia)
Pont, Angels (Hospital del Mar (Barcelona, Catalunya))
Pardo Cladellas, Yolanda (Universitat Autònoma de Barcelona. Departament de Psiquiatria i de Medicina Legal)
Goñi, Alai (Institutu Onkologikoa)
Mariño, Alfonso (Centro Oncológico de Galicia)
Hervás Morón, Asunción (Hospital Universitario Ramón y Cajal (Madrid))
Herruzo, Ismael (Hospital Regional Universitario (Màlaga, Andalusia))
Cabrera, Patricia (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Sancho-Pardo, Gemma (Institut de Recerca Sant Pau)
Ponce de León Roca, Javier (Institut de Recerca Sant Pau)
Macías Hernández, Víctor (Hospital Universitari i Politècnic La Fe (València))
Gutiérrez, Cristina (Hospital del Mar (Barcelona, Catalunya))
Castells, Manuel 1942- (Hospital Universitari de Bellvitge)
Ferrer Forés, Maria Montserrat (Universitat Pompeu Fabra)

Date:	2025
Abstract:	Our study presents new results over a period of 20 years after treatment for localized prostate cancer, including differences that are important for shared decision-making. The greatest urinary incontinence occurred after radical prostatectomy, and the least deterioration in sexual function occurred after brachytherapy. Our objective was to compare the impact of open radical prostatectomy (RP), external beam radiotherapy (EBRT), and brachytherapy in patients with localized prostate cancer via patient-reported outcome measures up to 20 yr after treatment. This was a prospective observational study (ClinicalTrials. gov ) of men with localized prostate cancer (clinical stage T1-T2, low or intermediate risk). The Expanded Prostate Cancer Index Composite (EPIC-26) and Short Form-36 (SF-36) questionnaires were centrally administered via telephone interviews before treatment and then annually after treatment. Generalized estimating equation models were constructed with propensity score-based weights. The RP group reported gradual, statistically significant worsening for almost all EPIC-26 and SF-36 scores at most follow-up time points. Significantly lower urinary incontinence deterioration was observed in both radiotherapy groups than after RP. Urinary irritative/obstructive, sexual, bowel, and hormonal symptom patterns were similar regardless of treatment, except for less sexual deterioration in the brachytherapy group. The observational design is the main limitation, but propensity score weights mitigated treatment selection bias. Our findings provide detailed novel evidence, measured over 20 yr, on the long-term impact of disease and treatment on patients with localized prostate cancer. While all treatment groups showed a general deterioration over time, important differences in urinary incontinence (highest after RP) and sexual decline (least after brachytherapy) persisted at 20 yr, and these should be incorporated into shared decision-making processes. Our study provides new findings on outcomes of treatment for localized prostate cancer as reported by patients over a period of up to 20 years. There was a general deterioration over time, but worse urinary incontinence after radical prostatectomy and the lowest decline in sexual function after brachytherapy persisted over time. These findings can inform patients during shared decision-making on the most suitable treatment for localized prostate cancer.
Grants:	Ministerio de Economía y Competitividad PI13/00412 Instituto de Salud Carlos III PI21/00023 Generalitat de Catalunya 2021SGR00624 Generalitat de Catalunya 2017SGR452
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 ; Localized prostate cancer ; Patient-reported outcome measures ; External radiotherapy ; Radical prostatectomy ; Brachytherapy
Published in:	European Urology Open Science, Vol. 82 (November 2025) , p. 160-167, ISSN 2666-1683

DOI: 10.1016/j.euros.2025.10.007
PMID: 41311640

8 p, 1.3 MB

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