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Time Course and Predictors of Symptoms After Primary Prostate Cancer Therapy

James A. Talcott, Judith Manola, Jack A. Clark, Irving Kaplan, Clair J. Beard, Sonya P. Mitchell, Ronald C. Chen, Michael P. O’Leary, Philip W. Kantoff, Anthony V. D’Amico

From the Center for Outcomes Research, MGH Cancer Center, Massachusetts General Hospital; Boston University School of Public Health; Dana-Farber Cancer Institute; Brigham and Women’s Hospital; Beth Israel-Deaconess Medical Center; Harvard Medical School, Boston; Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA.

Address reprint requests to James A. Talcott, MD, Center for Outcomes Research, Massachusetts General Hospital, B75 230, 55 Fruit St, Boston, MA 02114-2696; e-mail: jtalcott{at}partners.org.

Purpose: Understanding the distinctive patterns of treatment-related dysfunction after alternative initial treatments for early prostate cancer (PC) may improve patients’ choice of treatment and later help them adjust to its consequences. We characterized the time course of treatment complications while adjusting for potentially confounding pretreatment factors hindering other observational studies.

Patients and Methods: In a prospective cohort study of 417 men we assessed urinary, bowel, and sexual function from before primary treatment to 24 months after. To control for potential confounding, we measured sociodemographic and PC prognostic factors, medical comorbidity, and pretreatment function commonly affected by PC and its treatment.

Results: Patients who underwent external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT) differed significantly in sociodemographic factors, cancer prognostic factors, and pretreatment symptom status, especially sexual function. Urinary incontinence increased sharply after RP, while bowel problems and urinary irritation/obstruction rose after EBRT and BT. Sexual dysfunction increased in all patients, particularly after radical prostatectomy, and nerve-sparing surgical technique had little apparent benefit. There was no change in urinary function and little change in overall bowel function after 12 months, but the time course of sexual dysfunction varied by treatment and, for bowel function, by symptom. Multiple regression modeling confirmed that treatment influences all 24-month outcomes, but residual confounding persisted.

Conclusion: Pretreatment function and the primary treatment modality for early stage PC strongly predict the affected organ systems and time course of dysfunction. With this information, patients and their physicians may refine their choice of treatment and better anticipate its consequences.

Supported by an Agency for Healthcare Research and Quality grant, HS08208.

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