Time course and predictors of symptoms after primary prostate cancer therapy.
OBJECTIVE
Understanding the distinctive patterns of treatment-related dysfunction after alternative initial treatments for early prostate cancer (PC) may improve patients' choice of treatment and later help them adjust to its consequences. We characterized the time course of treatment complications while adjusting for potentially confounding pretreatment factors hindering other observational studies.


METHODS
In a prospective cohort study of 417 men we assessed urinary, bowel, and sexual function from before primary treatment to 24 months after. To control for potential confounding, we measured sociodemographic and PC prognostic factors, medical comorbidity, and pretreatment function commonly affected by PC and its treatment.


RESULTS
Patients who underwent external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT) differed significantly in sociodemographic factors, cancer prognostic factors, and pretreatment symptom status, especially sexual function. Urinary incontinence increased sharply after RP, while bowel problems and urinary irritation/obstruction rose after EBRT and BT. Sexual dysfunction increased in all patients, particularly after radical prostatectomy, and nerve-sparing surgical technique had little apparent benefit. There was no change in urinary function and little change in overall bowel function after 12 months, but the time course of sexual dysfunction varied by treatment and, for bowel function, by symptom. Multiple regression modeling confirmed that treatment influences all 24-month outcomes, but residual confounding persisted.


CONCLUSIONS
Pretreatment function and the primary treatment modality for early stage PC strongly predict the affected organ systems and time course of dysfunction. With this information, patients and their physicians may refine their choice of treatment and better anticipate its consequences.
Center for Outcomes Research, MGH Cancer Center, Massachusetts General Hospital, Boston, 02114-2696, USA. jtalcott@partners.org
James A
JA
Talcott
Judithy
J
Manola
Jack A
JA
Clark
Irving
I
Kaplan
Clair J
CJ
Beard
Sonya P
SP
Mitchell
Ronald C
RC
Chen
Michael P
MP
O'Leary
Philip W
PW
Kantoff
Anthony V
AV
D'Amico
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D014524:Urethral Obstruction / Q000453:epidemiology / Q000209:etiology; D001743:Urinary Bladder / Q000528:radiation effects; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology