Relief of Urinary Symptom Burden after Primary Prostate Cancer Treatment.
Harms of prostate cancer treatment on urinary health related quality of life have been thoroughly studied. In this study we evaluated not only the harms but also the potential benefits of prostate cancer treatment in relieving the pretreatment urinary symptom burden.



In American (1,021) and Spanish (539) multicenter prospective cohorts of men with localized prostate cancer we evaluated the effects of radical prostatectomy, external radiotherapy or brachytherapy in relieving pretreatment urinary symptoms and in inducing urinary symptoms de novo, measured by changes in urinary medication use and patient reported urinary bother.



Urinary symptom burden improved in 23% and worsened in 28% of subjects after prostate cancer treatment in the American cohort. Urinary medication use rates before treatment and 2 years after treatment were 15% and 6% with radical prostatectomy, 22% and 26% with external radiotherapy, and 19% and 46% with brachytherapy, respectively. Pretreatment urinary medication use (OR 1.4, 95% CI 1.0-2.0, p = 0.04) and pretreatment moderate lower urinary tract symptoms (OR 2.8, 95% CI 2.2-3.6) predicted prostate cancer treatment associated relief of baseline urinary symptom burden. Subjects with pretreatment lower urinary tract symptoms who underwent radical prostatectomy experienced the greatest relief of pretreatment symptoms (OR 4.3, 95% CI 3.0-6.1), despite the development of deleterious de novo urinary incontinence in some men. The magnitude of pretreatment urinary symptom burden and beneficial effect of cancer treatment on those symptoms were verified in the Spanish cohort.



Men with pretreatment lower urinary tract symptoms may experience benefit rather than harm in overall urinary outcome from primary prostate cancer treatment. Practitioners should consider the full spectrum of urinary symptom burden evident before prostate cancer treatment in treatment decisions.
Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. Electronic address: pchang@bidmc.harvard.edu.
Peter
P
Chang
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.
Meredith M
MM
Regan
Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
Montserrat
M
Ferrer
Department of Radiation Oncology, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.
Ferran
F
Guedea
Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
Dattatraya
D
Patil
Department of Urology, University of Michigan, Ann Arbor, Michigan.
John T
JT
Wei
Office for Survey Research, Institute for Public Policy and Social Research, Michigan State University, East Lansing, Michigan.
Larry A
LA
Hembroff
Department of Radiation Oncology, Washington University, St. Louis, Missouri.
Jeff M
JM
Michalski
Department of Urology, UCLA Center for Health Sciences, Los Angeles, California.
Chris S
CS
Saigal
Department of Urology, UCLA Center for Health Sciences, Los Angeles, California; Department of Health Policy and Management, UCLA Center for Health Sciences, Los Angeles, California.
Mark S
MS
Litwin
Texas Center for Proton Therapy, Irving, Texas.
Daniel A
DA
Hamstra
Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Irving D
ID
Kaplan
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
Jay P
JP
Ciezki
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Eric A
EA
Klein
Division of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Adam S
AS
Kibel
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
Howard M
HM
Sandler
Department of Urology, University of Michigan, Ann Arbor, Michigan.
Rodney L
RL
Dunn
Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Catrina M
CM
Crociani
Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
Martin G
MG
Sanda
D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D017281:Cost of Illness; D005500:Follow-Up Studies; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011471:Prostatic Neoplasms / Q000628:therapy*; D011788:Quality of Life; D016896:Treatment Outcome
outcome assessment (health care); patient-centered care; prostatic neoplasms; quality of life; surveys and questionnaires