External beam radiotherapy vs radical prostatectomy: Which is better for prostate cancer treatment?

External beam radiation therapy with low-dose rate brachytherapy boost appears to result in worse urinary irritative/obstructive and bowel functions but better urinary incontinence function through 5 years after treatment when compared to radical prostatectomy, reports a recent study.

Men aged <80 years with localized prostate adenocarcinoma were enrolled and followed longitudinally from 2011 to 2012. Patient-reported outcomes included the Expanded Prostate Index Composite. The researchers then constructed regression models for baseline scores and covariates.

A total of 112 men were treated with external beam radiation therapy plus low-dose rate brachytherapy boost and 1,553 with radical prostatectomy.

External beam radiation therapy, compared with radical prostatectomy, correlated with “clinically meaningful” worse urinary irritative/obstructive (adjusted mean score difference [MSD], 5.0, 95 percent confidence interval [CI], ‒8.7 to ‒1.3; p=0.008) but better urinary incontinence function (adjusted MSD, 13.3, 95 percent CI, 7.7‒18.9; p<0.001) at 5 years.

Urinary function bother was comparable between the two treatment groups (p>0.4 at all timepoints).

Compared to radical prostatectomy, external beam radiation therapy with low-dose rate brachytherapy boost correlated with worse bowel function (adjusted MSD, ‒4.0, 95 percent CI, ‒6.9 to ‒1.1; p=0.006) through 5 years.

In addition, external beam radiation therapy with low dose rate brachytherapy boost resulted in better sexual function at 1 year (adjusted MSD, 12.0, 95 percent CI, 6.5‒17.5; p<0.001) compared with radical prostatectomy. However, evidence was insufficient to reject the assumption that no difference was observed at 3 or 5 years.

“These patient-reported functional outcomes may clarify treatment expectations and help inform treatment choices for localized prostate cancer,” the researchers said.