title: Long-term adverse effects after curative radiotherapy and radical prostatectomy: population-based nationwide register study.
abstract: OBJECTIVE
  The aim of this study was to assess the risk of serious adverse effects after radiotherapy (RT) with curative intention and radical prostatectomy (RP).
  
  
  METHODS
  Men who were diagnosed with prostate cancer between 1997 and 2012 and underwent curative treatment were selected from the Prostate Cancer data Base Sweden. For each included man, five prostate cancer-free controls, matched for birth year and county of residency, were randomly selected. In total, 12,534 men underwent RT, 24,886 underwent RP and 186,624 were controls. Adverse effects were defined according to surgical and diagnostic codes in the National Patient Registry. The relative risk (RR) of adverse effects up to 12 years after treatment was compared to controls and the risk was subsequently compared between RT and RP in multivariable analyses.
  
  
  RESULTS
  Men with intermediate- and localized high-risk cancer who underwent curative treatment had an increased risk of adverse effects during the full study period compared to controls: the RR of undergoing a procedures after RT was 2.64 [95% confidence interval (CI) 2.56-2.73] and after RP 2.05 (95% CI 2.00-2.10). The risk remained elevated 10-12 years after treatment. For all risk categories of prostate cancer, the risk of surgical procedures for urinary incontinence was higher after RP (RR 23.64, 95% CI 11.71-47.74), whereas risk of other procedures on the lower urinary tract and gastrointestinal tract or abdominal wall was higher after RT (RR 1.67, 95% CI 1.44-1.94, and RR 1.86, 95% CI 1.70-2.02, respectively).
  
  
  CONCLUSIONS
  The risk of serious adverse effects after curative treatment for prostate cancer remained significantly elevated up to 12 years after treatment.
authors.affiliation: a Department of Surgical and Perioperative Sciences, Urology and Andrology , Umeå University , Umeå , Sweden ;
authors.forename: Jón Ö
authors.initials: JÖ
authors.lastname: Fridriksson
authors.affiliation: b Regional Cancer Center Uppsala Örebro , Uppsala University Hospital , Uppsala , Sweden ;
authors.forename: Yasin
authors.initials: Y
authors.lastname: Folkvaljon
authors.affiliation: c Department of Oncology and Radiation Physics , Skåne University Hospital, Lund University , Lund , Sweden ;
authors.forename: Per
authors.initials: P
authors.lastname: Nilsson
authors.affiliation: a Department of Surgical and Perioperative Sciences, Urology and Andrology , Umeå University , Umeå , Sweden ;|d Department of Urology , Ryhov Hospital , Jönköping , Sweden ;
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.affiliation: e Department of Oncology and Radiation Physics , Sahlgrenska University Hospital , Gothenburg , Sweden ;
authors.forename: Ingela
authors.initials: I
authors.lastname: Franck-Lissbrant
authors.affiliation: f Department of Surgery, Urology Service , Memorial Sloan-Kettering Cancer Center , New York City , NY , USA ;
authors.forename: Behfar
authors.initials: B
authors.lastname: Ehdaie
authors.affiliation: f Department of Surgery, Urology Service , Memorial Sloan-Kettering Cancer Center , New York City , NY , USA ;
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
authors.affiliation: g Department of Radiation Sciences, Oncology , Umeå University , Umeå , Sweden ;
authors.forename: Anders
authors.initials: A
authors.lastname: Widmark
authors.affiliation: g Department of Radiation Sciences, Oncology , Umeå University , Umeå , Sweden ;
authors.forename: Camilla T
authors.initials: CT
authors.lastname: Karlsson
authors.affiliation: a Department of Surgical and Perioperative Sciences, Urology and Andrology , Umeå University , Umeå , Sweden ;|h Department of Surgical Sciences , Uppsala University , Uppsala , Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Stattin
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects; D012042:Registries; D013548:Sweden; D013997:Time Factors
keywords: Adverse effects; prostate cancer; radical prostatectomy; radiotherapy