Patient-Reported Functional Decline Following Active Surveillance (AS), Radical Prostatectomy (RP), External Beam Radiation without Androgen Deprivation Therapy (EBRT w/o ADT), or Low-Dose-Rate Brachytherapy (LDR-BR) for Favorable-Risk Prostate Cancer

Purpose/Objective(s)

In the primary analysis of the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study, most comparative patient-reported functional differences between treatments for localized prostate cancer attenuated within five years. This secondary analysis describes clinically meaningful functional decline after treatment to better inform patients’ expectations.

Materials/Methods

Participants diagnosed with localized prostate cancer between 2011 and 2012 were prospectively enrolled from 5 United States Surveillance, Epidemiology and End Results Program Sites. The validated 26-item Expanded Prostate Index Composite questionnaire (range = 0-100) was administered at baseline and at 1-, 3-, 5-, and 10 years. Functional change from baseline was calculated at each time point. Established thresholds for clinically meaningful functional decline (CMFD) were used: 10 sexual function (fxn), 6 urinary incontinence (incon); 5 urinary irritative (irr); 4 bowel fxn. Descriptive statistics report function and problems for participants with favorable-risk (cT1 to cT2bN0M0, prostate-specific antigen ≤ 20 ng/mL, and Grade Group 1-2) prostate cancer selecting a specific treatment. Unadjusted analyses were performed; results should not be compared across treatment groups.

Results

Among 1,656 men with favorable-risk prostate cancer, 322 were treated with AS, 999 with RP, 252 with EBRT w/o ADT, and 83 with LDR-HR and completed the baseline and at least 1 postbaseline survey. Median [interquartile range] age, 63 [IQR = 58-69] years; 76.2% non-Hispanic white. Most RP was nerve-sparing (85.6%) and most EBRT was IMRT (77.6%) or proton (8.1%) with IGRT (83.9%). The proportion of participants with CMFD in each functional domain and with “moderate to big problem” (MTBP) with sexual, urinary, and bowel function at each time point are reported in the table below. Fewer patients reported a MTBP with function than those reporting CMFD.

Conclusion

Our findings highlight long-term clinically meaningful functional declines and functional problems that occur after these management approaches for favorable-risk prostate cancer. Patients should be counseled regarding risks of possible long-term functional impact to better inform them of expectations after treatment.