title: Complications following surgery with or without radiotherapy or radiotherapy alone for prostate cancer.
abstract: BACKGROUND
  Men undergoing treatment of clinically localised prostate cancer may experience a number of treatment-related complications, which affect their quality of life.
  
  
  METHODS
  On the basis of population-based retrospective cohort of men undergoing surgery, with or without subsequent radiotherapy, or radiotherapy alone for prostate cancer in Ontario, Canada, we measured the incidence of treatment-related complications using administrative and billing data.
  
  
  RESULTS
  Of 36 984 patients, 15 870 (42.9%) underwent surgery alone, 4519 (12.2%) underwent surgery followed by radiotherapy, and 16 595 (44.9%) underwent radiotherapy alone. For all end points except urologic procedures, the 5-year cumulative incidence rates were lowest in the surgery only group and highest in the radiotherapy only group. Intermediary rates were seen in the surgery followed by radiotherapy group, except for urologic procedures where rates were the highest in this group. Although age and comorbidity were important predictors, radiotherapy as the primary treatment modality was associated with higher rates for all complications (adjusted hazard ratios 1.6-4.7, P=0.002 to <0.0001).
  
  
  CONCLUSIONS
  In patients treated for prostate cancer, radiation after surgery increases the rate of complications compared with surgery alone, though these rates remain lower than patients treated with radiation alone. This information may inform patient and physician decision making in the treatment of prostate cancer.
authors: Division of Urology, Toronto, ON, Canada M4N3M5.
authors: C J D
authors: CJ
authors: Wallis
authors: Department of Radiation Oncology, Toronto, ON, Canada M4N3M5.
authors: P
authors: P
authors: Cheung
authors: Division of Urology, Toronto, ON, Canada M4N3M5.
authors: S
authors: S
authors: Herschorn
authors: Institute of Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Ave., Toronto, ON, Canada M4N3M5.
authors: R
authors: R
authors: Saskin
authors: Institute of Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Ave., Toronto, ON, Canada M4N3M5.
authors: J
authors: J
authors: Su
authors: Division of Urology, Toronto, ON, Canada M4N3M5.
authors: L H
authors: LH
authors: Klotz
authors: Division of Urology, University Health Network, University of Toronto, 610 University Ave., Toronto, ON, Canada M5G2M9.
authors: G S
authors: GS
authors: Kulkarni
authors: Department of Medicine, St Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada M5B1W8.
authors: Y
authors: Y
authors: Lee
authors: Division of Urology, Toronto, ON, Canada M4N3M5.
authors: R T
authors: RT
authors: Kodama
authors: Department of Public Health Sciences, University of Toronto, 790 Bay St, Toronto, ON, Canada M5G1N8.
authors: S A
authors: SA
authors: Narod
authors: Division of Urology, Toronto, ON, Canada M4N3M5.
authors: R K
authors: RK
authors: Nam
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009864:Ontario; D011183:Postoperative Complications / Q000209:etiology; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome