Twenty-year Patient-reported Outcomes After Surgery, Radiotherapy, or Brachytherapy for Localized Prostate Cancer
Por:
Zamora, V, Garin, O, Suárez, JF, Guedea, F, Pont, A, Pardo, Y, Goñi, A, Mariño, A, Hervás, A, Herruzo, I, Cabrera, P, Sancho, G, León, JPD, Macías, V, Gutiérrez, C, Castells, M, Ferrer, M
Publicada:
1 dic 2025
Ahead of Print:
1 nov 2025
Resumen:
Background and objective: Our objective was to compare the impact of open radical prostatectomy (RP), external beam radiotherapy (EBRT), and brachytherapy in patients with localized prostate cancer via patient-reported outcome measures up to 20 yr after treatment. Methods: This was a prospective observational study (ClinicalTrials.gov NCT01492751) of men with localized prostate cancer (clinical stage T1-T2, low or intermediate risk). The Expanded Prostate Cancer Index Composite (EPIC-26) and Short Form-36 (SF-36) questionnaires were centrally administered via telephone interviews before treatment and then annually after treatment. Generalized estimating equation models were constructed with propensity score-based weights. Key findings and limitations: The RP group reported gradual, statistically significant worsening for almost all EPIC-26 and SF-36 scores at most follow-up time points. Significantly lower urinary incontinence deterioration was observed in both radiotherapy groups than after RP. Urinary irritative/obstructive, sexual, bowel, and hormonal symptom patterns were similar regardless of treatment, except for less sexual deterioration in the brachytherapy group. The observational design is the main limitation, but propensity score weights mitigated treatment selection bias. Conclusions and clinical implications: Our findings provide detailed novel evidence, measured over 20 yr, on the long-term impact of disease and treatment on patients with localized prostate cancer. While all treatment groups showed a general deterioration overtime, important differences in urinary incontinence (highest after RP) and sexual decline (least after brachytherapy) persisted at 20 yr, and these should be incorporated into shared decision-making processes. Patient summary: Our study provides new findings on outcomes of treatment for localized prostate cancer as reported by patients over a period of up to 20 years. There was a general deterioration over time, but worse urinary incontinence after radical prostatectomy and the lowest decline in sexual function after brachytherapy persisted over time. These findings can inform patients during shared decision-making on the most suitable treatment for localized prostate cancer. (c) 2025 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creative-commons.org/licenses/by-nc-nd/4.0/).
Filiaciones:
Zamora, V:
Hosp Mar Res Inst, Hlth Serv Res Grp, Barcelona Biomed Res Pk,Doctor Aiguader 88, Barcelona 08003, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Epidemiol & Salud Publ, Madrid, Spain
Garin, O:
Hosp Mar Res Inst, Hlth Serv Res Grp, Barcelona Biomed Res Pk,Doctor Aiguader 88, Barcelona 08003, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Epidemiol & Salud Publ, Madrid, Spain
Univ Pompeu Fabra, Barcelona, Spain
Barcelona Biomed Res Pk, Hlth Serv Res Grp, IMIM Hosp Mar Med Res Inst, Off 144 Doctor Aiguader,88, Barcelona 08003, Spain
Suárez, JF:
Hosp Univ Bellvitge, Lhospitalet De Llobregat, Spain
Guedea, F:
Inst Catala Oncol, Lhospitalet De Llobregat, Spain
Pont, A:
Hosp Mar Res Inst, Hlth Serv Res Grp, Barcelona Biomed Res Pk,Doctor Aiguader 88, Barcelona 08003, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Epidemiol & Salud Publ, Madrid, Spain
Pardo, Y:
Hosp Mar Res Inst, Hlth Serv Res Grp, Barcelona Biomed Res Pk,Doctor Aiguader 88, Barcelona 08003, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Epidemiol & Salud Publ, Madrid, Spain
Univ Autonoma Barcelona, Cerdanyola Del Valles, Spain
Goñi, A:
Inst Onkol, San Sebastian, Spain
Mariño, A:
Ctr Oncol Galicia, Radiat Oncol Serv, La Coruna, Spain
Hervás, A:
Hosp Ramon & Cajal, Radiat Oncol, Madrid, Spain
Herruzo, I:
Hosp Reg Carlos Haya, Serv Radiodiagnost, Malaga, Spain
Cabrera, P:
Hosp Virgen Rocio, Radiat Oncol Serv, Seville, Spain
Sancho, G:
Hosp Santa Creu i Sant Pau, Radiat Oncol Serv, Barcelona, Spain
León, JPD:
Fundacio Puigvert, Serv Urol, Barcelona, Spain
Macías, V:
Hosp Univ & Politecn La Fe, Valencia, Spain
Gutiérrez, C:
Inst Catala Oncol, Lhospitalet De Llobregat, Spain
Hosp Del Mar, Radiat Oncol Dept, Barcelona, Spain
Castells, M:
Hosp Univ Bellvitge, Lhospitalet De Llobregat, Spain
Ferrer, M:
Hosp Mar Res Inst, Hlth Serv Res Grp, Barcelona Biomed Res Pk,Doctor Aiguader 88, Barcelona 08003, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Epidemiol & Salud Publ, Madrid, Spain
Univ Pompeu Fabra, Barcelona, Spain
Barcelona Biomed Res Pk, Hlth Serv Res Grp, IMIM Hosp Mar Med Res Inst, Off 144 Doctor Aiguader,88, Barcelona 08003, Spain
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