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Interventions for Urinary Morbidity Long Term after Prostate Cancer Treatment
Peter Chang1, Meredith M Regan2, John T Wei3, Larry A Hembroff4, Chris S Saigal5, Jeff M Michalski6, Eric A Klein7, David P Wood, Jr3, Martin G Sanda8, The PROST-QA Study Group8
1Beth Israel Deaconess Medical Center/Brigham and Women's Hospital, Boston, MA;2Dana Farber Cancer Institute, Boston, MA;3University of Michigan School of Medicine, Ann Arbor, MI;4Institute for Public Policy and Social Research, Michigan State University, East Lansing, MI;5UCLA Center for Health Sciences, Los Angeles, CA;6Washington University School of Medicine, St. Louis, MO;7Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH;8Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Urinary medication usage and/or procedural interventions to manage post-treatment urinary morbidity - concrete and clinically relevant endpoints - have not been previously compared after primary PCa treatment.
Materials & Methods:
A multicenter prospective cohort of 1,201 PCa patients who underwent radical prostatectomy (RP, 603), external radiotherapy (XRT, 298) or brachytherapy (BT, 302) from 2003 to 2006 had quality-of-life data collected from pre- to 2 years post-treatment. Treatment group differences in urinary medication usage, procedural interventions, and EPIC-26 overall urinary bother were analyzed using longitudinal logistic regression.
The number of XRT patients using urinary medications pre-treatment (n=53; 22%) remained unchanged post-treatment (n=56; 26%). BT patients required more urinary medications from pre- (n=50; 19%) to post-treatment (n=109; 46%; p < 0.0001). Conversely, RP patients used significantly fewer urinary medications from pre- (n=76; 14%) to post-treatment (n=32; 6%; p < 0.0001). Urinary medication usage at 2 years was lower after RP and XRT than after BT (p < 0.001), whereas procedural interventions were similar after XRT, RP, and BT, respectively (5%, 7%, and 10%; p = 0.20). The number of patients experiencing moderate to severe overall urinary bother from pre- to post-treatment was unchanged in XRT (24 to 23), increased in BT (20 to 37), and decreased in RP (58 to 38).
Long-term medical intervention for urinary problems was more common after radiotherapy, especially brachytherapy, than after prostatectomy, suggesting that the previously underappreciated burden of obstructive urinary problems after radiation is paramount to the accepted burden of incontinence after prostatectomy.
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