Complications from treatment for prostate carcinoma among men in the Detroit area.

Background: Aggressive treatment of early stage prostate carcinoma (PC) is limited primarily to two modalities: radical prostatectomy (RP) and external beam radiation therapy (RT). The authors conducted a population-based study of Detroit area men with localized PC to determine the outcome of bowel, urinary, and sexual function after aggressive treatment.

Methods: Men with PC were identified through the Metropolitan Detroit Cancer Surveillance System, a member of the National Cancer Institute Surveillance, Epidemiology, and End Results Program. Patients participated in interviews about their pretreatment bowel, urinary, and sexual function approximately 9 months after treatment. The same men were asked identical questions about their function an average of 2 years after treatment. Treatment outcomes were compared for men who underwent RP and men who received RT.

Results: Of 501 men, 398 (79.4%) participated in both interviews, 304 of whom (76.4%) had localized PC and had been treated at least 1 year previously (median, 688 days). One hundred thirty men underwent RP, and 115 men received RT. The proportion of men in the RP group who reported an increase in incontinence symptoms was significant (53.8% compared with 19.2% in the RT group; P < 0.001). Men in the RT group reported increased loose stools between the pretreatment and post-treatment interviews (5.2% vs. 29.6%; P < 0.001). Men in both the RT group and the RP group reported increases in impotence from 40% to > 75% (P < 0.001 for both). Men in the RT group were 3.6 times more likely to have bowel incontinence compared with men in the RP group (odds ratio [OR], 3.61; 95% confidence interval [95% CI], 1.54-8.47). Urinary incontinence (OR, 2.87; 95% CI, 1.52-5.44) and erection difficulty (OR, 3.98; 95% CI, 1.35-11.70) were more likely among men in the RP group.

Conclusions: Although patients may have recalled their baseline function as better than it was, the current results are consistent with other population-based studies of treatment outcomes among men with localized PC. They indicate that the side effects associated with treatment are greater than those based on case series. Physicians and patients should be aware of these population-based outcomes and should use them as part of the decision-making process regarding the treatment options for men with PC.