Retrospective cohort study of long-term adverse effects and complications after prostate cancer treatment

Due to the often indolent nature of prostate cancer (PCA), treatment decisions must weigh the risks and benefits of cancer control with those of treatment-associated morbidities. A retrospective cohort study quantified the 12-year risks of complications after prostatectomy or radiotherapy. Compared with patients who did not receive treatment, the age, race, and year of time-at-risk initiation adjusted risk of urinary or sexual complications was more than 7 times greater with prostatectomy (HR 7.23; p<0.001) and almost 3 times greater with radiotherapy (HR 2.76; p<0.001). Compared with no treatment, radiotherapy was associated with increased risk of bladder cancer (HR 2.78; p<0.001), cystitis (131.47; p<0.001), and proctitis (87.91; p<0.001). The incidence per 1000 person-years of any one of ten analyzed treatment-related complications was 124.26 in the prostatectomy group, 62.15 in the radiotherapy group, and 23.61 in the no-treatment group. The authors conclude that, even after accounting for age-related symptoms and disease, PCA treatment was associated with higher rates of complications in the 12 years after treatment.