Clinical Question: Are rates of side effects comparable in men with localized prostate cancer who are treated with external beam radiation or radical prostatectomy?

Setting: Population-based

Study Design: Cohort (prospective)

Synopsis: Researchers identified a group of men 55 to 74 years of age with clinically localized prostate cancer. The Prostate Cancer Outcome Study was designed to prospectively evaluate the outcomes of 1,187 men who chose radical prostatectomy (n = 901) or external beam radiation (n = 286) in community settings.

Five years after treatment, the research team sent surveys to the participants to assess general and disease-specific quality of life. Additionally, the team reviewed the medical records one to two years after the initial diagnosis. The original cohort included 1,591 men, so the follow-up was only 75 percent (79 percent in the group treated with surgery and 67 percent in the group treated with radiation). After adjusting for other factors likely to affect continence, 15.3 percent of men treated with surgery were incontinent (defined as having no bladder control or frequently leaking urine) compared with 4.1 percent of patients treated with radiation (odds ratio [OR] = 4.4; 95 percent confidence interval [CI], 2.2 to 8.6; number needed to harm = 9). Additionally, erectile dysfunction was more prevalent in the radical prostatectomy group than in the external beam radiotherapy group (79.3 versus 63.5 percent; OR = 2.5; 95 percent CI, 1.6 to 3.8; number needed to harm = 6).

Bottom Line: Men with clinically localized prostate cancer who received radical prostatectomy are more likely to experience incontinence and erectile dysfunction than men treated with external beam radiation. (Level of Evidence: 2b)