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- Title
Local Treatment and Treatment-Related Adverse Effects Among Patients With Advanced Prostate Cancer.
- Authors
Khan, Saira; Chang, Su-Hsin; Wang, Mei; Kim, Eric H.; Schoen, Martin W.; Rocuskie-Marker, Carleena; Drake, Bettina F.
- Abstract
Key Points: Question: What is the burden of treatment-related adverse effects among men receiving local treatment with radical prostatectomy or radiation for advanced prostate cancer? Findings: In this retrospective cohort study of 5502 US veterans diagnosed with advanced prostate cancer, local (vs nonlocal) treatment was associated with adverse gastrointestinal, sexual, and urinary conditions within the year after initial treatment and remained significantly associated with these adverse conditions more than 2 years to 5 years or less after treatment. Meaning: Patients and clinicians should consider the adverse effects of local treatment when making treatment decisions in the setting of advanced prostate cancer. This cohort study of veterans with advanced prostate cancer assesses the prevalence of treatment-related adverse effects and their association with local vs nonlocal treatment. Importance: Recent data suggest that local treatment with radical prostatectomy or radiation may improve survival outcomes in men with advanced prostate cancer. However, evidence is lacking on treatment-related adverse effects among men with advanced prostate cancer. Objective: To assess the association of local treatment on treatment-related adverse effects among men diagnosed with advanced prostate cancer. Design, Setting, and Participants: This cohort study assessed men diagnosed with advanced prostate cancer (defined as T4, N1, and/or M1 prostate cancer) between January 1, 1999, and December 31, 2013, with follow-up through December 31, 2021, who were treated at Veterans Health Administration medical centers. Exposure: Local treatment with radical prostatectomy or radiation. Main Outcomes and Measures: Main outcomes were treatment-related adverse effects, including constitutional, gastrointestinal, pain, sexual function, and urinary function conditions, at 3 intervals after initial treatment (≤1 year, >1 to ≤2 years, and >2 to ≤5 years) after initial treatment. Results: This cohort study consisted of 5502 men (mean [SD] age, 68.7 [10.3] years) diagnosed with advanced prostate cancer. Of the cohort, 1705 men (31.0%) received local treatment. There was a high prevalence of adverse conditions in men receiving both local and nonlocal treatment, and these adverse conditions persisted for more than 2 years to 5 years or less after initial treatment. A total of 916 men (75.2%) with initial local treatment and 897 men (67.1%) with initial nonlocal treatment reported the presence of at least 1 adverse condition for more than 2 years to 5 years or less after initial treatment. In the first year, local treatment (vs nonlocal) was associated with adverse gastrointestinal (multivariable-adjusted odds ratio [AOR], 4.08; 95% CI, 3.06-5.45), pain (AOR, 1.57; 95% CI, 1.35-1.83), sexual (AOR, 2.96; 95% CI, 2.42-3.62), and urinary (AOR, 2.25; 95% CI, 1.90-2.66) conditions. Local treatment (without secondary treatment) remained significantly associated with adverse gastrointestinal (AOR, 2.39; 95% CI, 1.52-3.77), sexual (AOR, 3.36; 95% CI, 2.56-4.41), and urinary (AOR, 1.39; 95% CI, 1.09-1.78) conditions at more than 2 years to 5 years or less after treatment. Conclusions and Relevance: In this cohort study of men with advanced prostate cancer, local treatment was associated with persistent treatment-related adverse effects across multiple domains. These results suggest that patients and clinicians should consider the adverse effects of local treatment when making treatment decisions in the setting of advanced prostate cancer.
- Subjects
PROSTATE tumors treatment; PATIENT aftercare; VETERANS' hospitals; MEN'S health; PAIN; CONFIDENCE intervals; RADICAL prostatectomy; TIME; MULTIVARIATE analysis; URINATION disorders; GASTROINTESTINAL diseases; TUMOR classification; TREATMENT effectiveness; DECISION making; RESEARCH funding; ADVERSE health care events; RADIATION injuries; ODDS ratio; SENSITIVITY &; specificity (Statistics); PROSTATE tumors; LONGITUDINAL method; DISEASE risk factors; DISEASE complications
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2348057
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.48057