Surgery Improves Urinary Tract Symptoms in Localized Prostate Cancer Better Than Radiation

Surgery for localized prostate cancer resulted in greater improvements in lower urinary tract symptoms (LUTS) than radiation therapy among men with worse LUTS at baseline, indicating the need for urologists to consider baseline urinary symptoms in treatment decision-making, according to a study presented by Jacob Tallman, MD, of Vanderbilt University Medical Center, Nashville, TN, at the 2022 American Urological Association Annual Meeting.

Prostate volume and LUTS at baseline often help guide management of localized prostate cancer; however, there is little information to date to inform what degree these variables are associated with choice of therapy and urinary function after treatment.

In the most recent CEASAR study, Dr. Tallman and colleagues evaluated the association of prostate volume and LUTS at baseline with post-treatment urinary function in men with prostate cancer. The researchers stated that their hypothesis is larger prostate volume and worse LUTS at baseline are associated with choosing active surveillance or surgery over radiation therapy, which would also be related to greater improvements in post-treatment urinary symptoms.

The prospective cohort study included 1823 men with localized PCa who completed baseline and post-treatment surveys between from 2011 and 2012. The Expanded Prostate Index Composite (EPIC-26) was used to evaluate patient-reported health-related quality of life (HRQOL) over an up to 5-year follow-up period.

Patients in the study were grouped by their prostate volumes: 0 to 30cc, 31 to 50cc, 51 to 70cc, and 70+ cc. Additionally, patients were also grouped by baseline LUTS, as determined by urinary irritative domain scores of 0 to 75, 76 to 85, 86 to 95, and 95 to 100.

The median age of the patient population was 64 years. Approximately half (51%) of all patients had grade group 1 prostate cancer, while 28% had grade group 2 disease. More than half of patients (53%) underwent surgery to treat their prostate cancer, while 33% received radiation therapy and 14% underwent active surveillance.

In the cohort analysis, the investigators found a weak association between larger prostate volume and worse baseline LUTS (R = -0.17; p<0.001). The multivariable analysis by prostate volume found no clinically significant differences in choice of treatment or post-treatment LUTS.

Patients who had optimal urinary function at baseline experienced significantly fewer LUTS after treatment compared with patients who had worse urinary function at baseline. Despite this finding, the researchers found that patients who had suboptimal LUTS at baseline experienced improvement after treatment, with surgery resulting in greater improvements compared with radiation therapy. The investigators noted that the differences met “the minimum clinically important difference” of 9 points.