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Long term harms after treatment for prostate cancer

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f696 (Published 06 February 2013) Cite this as: BMJ 2013;346:f696

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Men who had a radical prostatectomy for localised prostate cancer reported worse urinary incontinence and worse sexual function five years later than similar men treated with external beam radiotherapy in a cohort study from the US. Compared with radiotherapy, surgery was associated with double the odds of serious erectile dysfunction at five years (75.7% v 71.9%; adjusted odds ratio 1.96, 95% CI 1.05 to 3.63) and five times higher odds of frequent urinary leakage or worse (13.4% v 4.4%; 5.10, 2.29 to 11.36).

Survivors were still reporting worse urinary incontinence 15 years after prostatectomy, although by then the difference was not significant (18.3% v 9.4%; 2.34, 0.88 to 6.23). Erectile dysfunction was almost universal among men who survived for 15 years after either treatment (87% v 93.9%).

Prostatectomy was associated with a lower odds of bowel urgency than radiotherapy five years after treatment (16.3% v 31.3%; 0.47, 0.26 to 0.84), but the difference was no longer significant after 15 years (21.9% v 35.8%; 0.98, 0.45 to 2.14).

The authors tracked a selected cohort of 1655 men treated for localised prostate cancer in the mid-1990s, when they were 55-74 years of age. Most (1164) had surgery. Comparisons between prostatectomy and radiotherapy were adjusted extensively in an attempt to compare similar men who simply had different treatments. A quarter of those who had surgery (322/1164; 27.7%) and a half of those who had radiotherapy (247/491; 50.3%) died during the long follow-up.

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Cite this as: BMJ 2013;346:f696