New Rates of Interventions to Manage Complications of Modern Prostate Cancer Treatment in Older Men

Abstract

Background: Interventions to treat complications from prostate cancer (PCa) treatment are common and affect the course of a patient's life.

Objective: To examine rates of complications other than urinary incontinence and impotence for older patients treated for PCa.

Design, setting, and participants: Population-based retrospective cohort study of patients aged 65-79 yr receiving radical prostatectomy or radiotherapy (RT) from 2001 to 2008 in the US Surveillance Epidemiology and End Results and Medicare linked databases.

Outcome measures and statistical analysis: Complications were organised in three categories: urologic procedures, rectal-anal procedures, and major surgeries. We analysed the role of primary treatment on the number of complications using negative binomial regression.

Results and limitations: Among 60476 men, 14492 underwent primary surgery and 45984 underwent primary RT; 33418 (55%) experienced at least one complication (mean: 2.6 complications per patient). For both groups, complications peaked within 2 yr of treatment but continued at a steady rate for 10 yr. Patients treated with radiation had higher rates of urologic procedures (adjusted relative rate [aRR]: 1.25; 95% confidence interval [CI], 1.2-1.3; p<0.0001) and rectal-anal procedures (aRR: 1.4; 95% CI, 1.4-1.5; p<0.0001) but a lower rate of major surgeries (aRR: 0.9; 95% CI, 0.8-0.9; p<0.0001) compared with those having surgery. Because patients treated with RT were older and more comorbid, selection bias limits the strength of conclusions that can be drawn from this data.

Conclusions: Complications are common following PCa cancer treatment and occur many years after treatment. The primary treatment is an important predictor of complication rates that may inform treatment decisions and long-term survivorship plans.

Patient summary: We examined complications after prostate cancer treatment in a large American population. Patients treated with radiotherapy rather than surgery had higher rates of complications requiring urologic procedures and rectal-anal procedures but lower rates of open surgeries. However, we were only able to examine men aged >65 yr, and this, along with the observational study technique, means that these results may not apply to all patients and that factors beyond those that we could measure may have affected these results.

Keywords: Brachytherapy; Computer-assisted radiotherapy; Intensity-modulated radiotherapy; Prostatectomy; Prostatic neoplasms; Retropubic.