Radical Prostatectomy Not Tied to Worse Sexual Function at 10 Years

Radical prostatectomy for localized prostate cancer is not associated with worse sexual function at 10 years compared with radiation therapy and active surveillance, a new observational study finds.

Investigators studied long-term functional outcomes in 2445 men diagnosed with localized prostate cancer in 2011-2012 from US Surveillance, Epidemiology, and End Results Program registries. At baseline, 1877 men had a favorable prognosis (cT1-cT2bN0M0, PSA level less than 20 ng/mL, and grade group 1-2) and 568 had an unfavorable prognosis (cT2cN0M0, PSA 20-50 ng/mL, or grade group 3-5). Patients completed the 26-item Expanded Prostate Cancer Index Composite at various times, including baseline and 10 years.

Among patients with favorable prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference -12.1), but not clinically worse sexual function at 10 years, compared with active surveillance (AS), external beam radiation therapy (EBRT), and brachytherapy, Daniel A. Barocas, MD, MPH, of Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues reported in JAMA. Among men with erections sufficient for intercourse at baseline, 41%, 43%, 48%, and 46% of the radical prostatectomy, EBRT, brachytherapy, and AS groups had erections sufficient for intercourse at 10 years, respectively.

At 10 years, however, radical prostatectomy was associated with significant 80% increased odds of moderate to large problems with sexual function compared with AS and with a higher likelihood of erections insufficient for intercourse compared with EBRT. During at least the first 3 years, surgery patients had significantly worse sexual function than EBRT, brachytherapy, and active surveillance.

Among patients with unfavorable prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference -26.6), but not clinically worse sexual function at 10 years, compared with EBRT with androgen deprivation therapy (EBRT+ADT), the investigators reported.

In the unfavorable prognosis group, EBRT+ADT was associated with worse bowel and hormone function (adjusted mean difference -4.9) compared with radical prostatectomy.

The results may not be generalizable to men with locally advanced disease and men older than 80 years because they were excluded from the study.

According to Dr Barocas’ team, “understanding associations of each treatment with functional outcomes, such as sexual, urinary, and bowel function, over long-term follow-up can help inform treatment selection.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Renal and Urology News