Assistant Attending Epidemiologist Memorial Sloan Kettering Cancer Center
Introduction: The two main alternatives for curative treatment of prostate cancer (PCa) are robot assisted radical prostatectomy (RARP) and radiotherapy (RT). We assessed outcomes after RARP and RT by use of Patient Reported Outcomes Measures (PROM) in a large, contemporary population. Methods: The National Prostate Cancer Register of Sweden (NPCR) includes information on almost all Swedish men with PCa. The PCa Data Base Sweden (PCBaSe) links data to multiple national population-based registries. PROM are distributed to all men scheduled for curative treatment. 12 month PROM were used to evaluate the outcomes erectile dysfunction, urinary symptoms, bowel dysfunction, and quality of life (QoL). Data for all men who completed 12 month PROM in PCBaSe 5.0 aged < 75 years, with clinical T1c-T3 or Tx, any Gleason score, preoperative PSA levels < l00 ng/mL, no metastases (N0, Nx. M0 or Mx) who underwent RARP or RT between 1 January 2018 and 31 December 2020 were analyzed (n = 4298). Comorbidities were assessed by Charlson Comorbidity Index and a Drug Comorbidity Index. Adjusted odds ratios (OR) for each outcome comparing RT vs RARP (reference) were obtained using logistic regression, adjusting for confounders at date of treatment (age, comorbidities, educational level, civil status, PSA, prostate volume, biopsies with cancer, cT-stage and Gleason score). Results: 2557 men underwent RARP and 1741 men received RT. On average, men who had undergone RT were 4 years older and had more comorbidities. The prevalence of erectile dysfunction was 80% among men who underwent RARP and 82% among RT. 13% of the men were incontinent one year after RARP while only 5% reported incontinence after RT. 17% of men treated with RT and 18% with RARP reported high urinary bother. 34% of men who underwent RT reported urgency to defecate compared to 14% of men treated with RARP. High QoL was reported by 85% of men who underwent RARP and 79% who underwent RT. RT was associated with lower risk of erectile dysfunction (OR 0.57, 95% CI 0.48-0.67), lower risk of urine incontinence (OR 0.24, 95% CI 0.19-0.32), lower urinary bother (OR 0.74, 95% CI 0.61-0.89) but higher risk of bowel related symptoms (OR 2.84 95%, CI: 2.40-3.37). RARP was associated with higher QoL (OR 1.33, 95% CI: 1.11-1.60). Conclusions: Results from this large, contemporary, and unselected population confirms previous reports on common side-effects after curative treatment for PCa. However, QoL is high regardless of treatment suggesting that factors other than side-effects are the main drivers of QoL. SOURCE OF Funding: National Institutes of Health/National Cancer Institute (K22 CA234400) to Dr. Carlsson and Hillevi Fries Research Foudation, Johanna Hagstrand and Sigfrid Linnérs Research Foundation, Nyströms America Scholarship, and the Swedish Society of Medicine to Dr. Bergengren.