title: Population-based study of long-term functional outcomes after prostate cancer treatment.
abstract: OBJECTIVE
  To evaluate long-term urinary, sexual and bowel functional outcomes after prostate cancer treatment at a median (interquartile range) follow-up of 12 (11-13) years.
  
  
  METHODS
  In this nationwide, population-based study, we identified 6 003 men diagnosed with localized prostate cancer (clinical local stage T1-2, any Gleason score, prostate-specific antigen <20 ng/mL, NX or N0, MX or M0) between 1997 and 2002 from the National Prostate Cancer Register, Sweden. The men were aged ≤70 years at diagnosis. A control group of 1 000 men without prostate cancer were also selected, matched for age and county of residence. Functional outcomes were evaluated with a validated self-reported questionnaire.
  
  
  RESULTS
  Responses were obtained from 3 937/6 003 cases (66%) and 459/1 000 (46%) controls. At 12 years after diagnosis and at a median age of 75 years, the proportion of cases with adverse symptoms was 87% for erectile dysfunction/sexual inactivity, 20% for urinary incontinence and 14% for bowel disturbances. The corresponding proportions for controls were 62, 6 and 7%, respectively. Men with prostate cancer, except those on surveillance, had an increased risk of erectile dysfunction compared with the men in the control group. Radical prostatectomy was associated with an increased risk of urinary incontinence (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.36-2.62) and radiotherapy increased the risk of bowel dysfunction (OR 2.46, 95% CI 1.73-3.49) compared with men in the control group. Multi-modal treatment, in particular treatment including androgen deprivation therapy (ADT), was associated with the highest risk of adverse effects; for instance, radical prostatectomy followed by radiotherapy and ADT was associated with an OR of 3.74 (95% CI 1.76-7.95) for erectile dysfunction and an OR of 3.22 (95% CI 1.93-5.37) for urinary incontinence.
  
  
  CONCLUSIONS
  The proportion of men who experienced a long-term impact on functional outcomes after prostate cancer treatment was substantial.
authors.affiliation: Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.|Department of Urology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Carlsson
authors.affiliation: Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Linda
authors.initials: L
authors.lastname: Drevin
authors.affiliation: New York University and Manhattan Veterans Affairs Medical Center, New York, NY, USA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Loeb
authors.affiliation: Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Widmark
authors.affiliation: Department of Oncology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
authors.forename: Ingela Franck
authors.initials: IF
authors.lastname: Lissbrant
authors.affiliation: Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden.|Department of Urology, Ryhov County Hospital, Jönköping, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.affiliation: Department of Surgical Sciences, University Hospital of Uppsala, Uppsala, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Johansson
authors.affiliation: Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Stattin
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Fransson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects; D016022:Case-Control Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D007172:Erectile Dysfunction / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000150:complications / Q000628:therapy*; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D012002:Rectal Diseases / Q000209:etiology; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology
chemical_list: D000726:Androgen Antagonists
keywords: erectile dysfunction; prostate cancer; prostatic neoplasms/therapy; quality of life; urinary incontinence