title: Propensity-weighted long-term risk of urinary adverse events after prostate cancer surgery, radiation, or both.
abstract: BACKGROUND
  Prostate cancer is the second most common cancer in men and has high survivorship, yet little is known about the long-term risk of urinary adverse events (UAEs) after treatment.
  
  
  OBJECTIVE
  To compare the long-term UAE incidence across treatment and control groups.
  
  
  METHODS
  Using a matched-cohort design, we identified elderly men treated with external-beam radiotherapy (EBRT; n=44 318), brachytherapy (BT; n=14 259), EBRT+BT (n=11 835), radical prostatectomy (RP; n=26 970), RP+EBRT (n=1557), or cryotherapy (n=2115) for non-metastatic prostate cancer and 144 816 non-cancer control individuals from the population-based Surveillance, Epidemiology, and End Results-Medicare linked data from 1992-2007 with follow-up through 2009.
  
  
  METHODS
  The incidence of treated UAEs and time from cancer treatment to first UAE were analyzed in terms of propensity-weighted survival.
  
  
  RESULTS
  Median follow-up was 4.14 yr. At 10 yr, all treatment groups experienced higher propensity-weighted cumulative UAE incidence than the control group (16.1%; hazard risk [HR] 1.0), with the highest incidence for RP+EBRT (37.8%; HR 3.19, 95% confidence interval [CI] 2.79-3.66), followed by BT+EBRT (28.4%; HR 1.97, CI 1.85-2.10), RP (26.6%; HR 2.44, CI 2.34-2.55), cryotherapy (23.4%; HR 1.56, CI 1.30-1.87), BT (19.8%; HR 1.43, CI 1.33-1.53), and EBRT (19.7%; HR 1.11, CI 1.07-1.16). Bladder outlet obstruction was the most common event.
  
  
  CONCLUSIONS
  Men undergoing RP, RP+EBRT, and BT+EBRT experienced the highest UAE risk at 10 yr, although UAEs accrued differently over extended follow-up. The significant background UAE rate among non-cancer control individuals yields a risk attributable to prostate cancer treatment that is 17% lower than prior estimates.
  
  
  RESULTS
  We show that treatment for prostate cancer, especially combinations of two treatments such as radiation and surgery, carries a significant risk of urinary adverse events such as urethral stricture. This risk increases with time since treatment, emphasizing that treatments have long-term effects.
authors.affiliation: Department of Urology, Medical School, University of Minnesota, Minneapolis, USA. Electronic address: sjarosek@umn.edu.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Jarosek
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA.
authors.forename: Haitao
authors.initials: H
authors.lastname: Chu
authors.affiliation: Department of Urology, Medical School, University of Minnesota, Minneapolis, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Elliott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000401:mortality; D003452:Cryosurgery / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D006278:Medicare; D057216:Propensity Score; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000009:adverse effects* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D011832:Radiation Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014525:Urethral Stricture / Q000175:diagnosis / Q000453:epidemiology; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis / Q000453:epidemiology; D014570:Urologic Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality
keywords: Outcomes research; Prostate cancer; Reconstructive urology; SEER-Medicare; Urinary adverse effects