Surgery or radiotherapy for localized prostate cancer associated with varying risks of complications

Robot-assisted laparoscopic prostatectomy (RALP) and radical external beam radiotherapy (RT) are associated with different patterns of complications and patient-reported outcomes (PROs) in Chinese patients with localized prostate cancer, with urinary incontinence being much more common after RALP, a retrospective study by the Chinese University of Hong Kong (CUHK) has shown.

In the study, data on 93 patients (age, 58–84 years) with localized prostate cancer diagnosed between January 2010 and December 2011 who had received either RALP (n=30) or RT (n=63) in the past 5–7 years were retrieved from hospital records. A validated Chinese version of the Expanded Prostate Index Composite Questionnaire (EPIC), comprising urinary, bowel and sexual domains, was used as a PRO measure to assess the patients’ quality of life (QoL) with their choice of treatment among 61.2 percent of all surviving patients (n=52 out of 85 patients). [Hong Kong Med J 2020;26:95-101]

Patients treated with RT had a significantly lower rate of achieving undetectable prostate-specific antigen level (46.0 percent vs 100 percent; p<0.001), as well as higher rates of biochemical recurrence (19.0 percent vs 6.7 percent; p=0.213) and metastasis (4.8 percent vs 0 percent; p=0.548) compared with those treated with RALP.

Most (≥92.1 percent) patients in both groups experienced urinary complications ≤3 months of primary treatment, whilst short-term bowel symptoms were reported at a significantly higher rate in the RT group (46.0 percent vs 6.7 percent; p<0.001) compared with the RALP group.

Patients in the RALP group continued to have a significantly higher rate of urinary incontinence after 3 months of treatment compared with the RT group (70.0 percent vs 3.2 percent; p<0.001). In contrast, rates of lower urinary tract symptoms (LUTS) other than incontinence and perirectal bleeding were significantly higher in the RT group (LUTS, 87.3 percent vs 50.0 percent; p<0.001) (perirectal bleeding, 36.5 percent vs 0 percent; p<0.001).

A significantly higher proportion of patients in the RALP group vs RT group experienced erectile dysfunction (85.2 percent vs 23.2 percent; p<0.001) and required treatment for the condition (60.9 percent vs 15.4 percent; p<0.001). Unplanned hospitalization related to prostate cancer was required in six vs zero patients who underwent RT vs RALP (p=0.172).

The RT group scored significantly higher on the EPIC urinary summary score and its subcomponents on urinary function and incontinence compared with the RT group (urinary summary, 88.9 vs 81.5; p=0.016) (urinary function, 93.6 vs 75.9; p<0.001) (incontinence, 91.8 vs 60.5; p<0.001). However, EPIC scores were similar between the RT and RALP groups on urinary bother and irritative/obstructive symptoms (urinary bother, 82.1 percent vs 75 percent; p=0.366) (irritative/obstructive symptoms, p=0.230).

Both groups scored high on the EPIC bowel summary score (92.9 for the RT group vs 92.0 for the RALP group; p=0.774), but low on the sexual summary score (22.4 percent vs 31.7 group; p=0.092). Scores on all bowel and sexual subcomponents were comparable between the groups (p>0.05).

“The new knowledge generated from this study provides information on the treatment complications associated with RALP and RT, and is important for patient consultation. Patients with localized prostate cancer would therefore be able to make informed decisions on their choice of treatment,” said first author Professor Chi-Fai Ng of the Department of Surgery, CUHK.