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prostate cancer outcomes

Clinical trials: - Prostate Cancer Outcomes study: 5 year outcomes - design: - 1187 men with localized prostate cancer - 901 received radical prostatectomy - 286 received external beam radiotherapy - results: - urinary incontinence less frequent in radiation group 4% vs 15% - bowel urgency more frequent in radiation group 29% vs 19% - painful hemorrhoids more frequent in radiation group 20% vs 10% - 50% of each group sexually inactive - rapid loss in 1st 6 months followed by gradual improvement in prostatectomy group - gradual decline in radiation therapy group - 15 year outcomes - 15 year cancer-specific mortality 3% wth active surveillance, radiation or prostatectomy [2] - overall mortality 22% - 61% of active surveillance transition to prostatectomy or radiation - metastases more common with active surveillance than prostatectomy or radiation (9.5% vs 5%) [2] - radical prostatectomy & radiation with equivalent 15 year outcomes [3,4] - prostatectomy with better survival than radiation therapy - 5 year mortality 1.4% vs 4.9% [5]

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References

  1. Journal Watch 24(22):169, 2004 Potosky AL, Davis WW, Hoffman RM et al Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the prostate cancer outcomes study. J Natl Cancer Inst. 2004 Sep 15;96(18):1358-67. PMID: 15367568
  2. Hamdy FC et al. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 2023 Mar 11; [e-pub]. PMID: 36912538 https://www.nejm.org/doi/10.1056/NEJMoa2214122 - Sartor O. Localized prostate cancer - Then and now. N Engl J Med 2023 Mar 11; [e-pub]. PMID: 3691256 https://www.nejm.org/doi/10.1056/NEJMe2300807 - Donovan JL et al. Patient-reported outcomes 12 years after localized prostate cancer treatment. NEJM Evid 2023 Mar 11; [e-pub]. PMID: 38320051 https://evidence.nejm.org/doi/10.1056/EVIDoa2300018
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  4. Resnick MJ et al Long-Term Functional Outcomes after Treatment for Localized Prostate Cancer. N Engl J Med 2013; 368:436-445January 31, 2013 http://www.nejm.org/doi/full/10.1056/NEJMoa1209978
  5. Sooriakumaran P et al Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes. BMJ 2014;348:g1502 PMID: 24574496 http://www.bmj.com/content/348/bmj.g1502