Introduction

While the optimal use and timing of secondary therapy after radical prostatectomy (RP) remain controversial, there are limited data on the patient-reported outcomes following multimodality therapy. Objective is to assess the impact of additional radiation (RT) and/or androgen deprivation therapy (ADT) on urinary continence, potency and quality of life (QoL) after RP.

Methods

Among 13150 men treated by RP from 1992-2013, 905 underwent RP+RT, 407 RP+ADT and 688 RP+RT+ADT. Urinary function, sexual function and overall QoL were evaluated annually using self-administrated validated questionnaires. Propensity score-matched and bootstrap analyses were performed, and the distribution of all functional outcomes were analyzed as a function of time after RP.

Results

Patients who received RP+RT had a 4% higher overall incontinence rate 3 years after surgery and 1% higher rate for severe incontinence (>3 pads/24h) compared to matched RP-only patients. ADT further increased the overall and severe incontinence rate by 4% and 3% compared to matched RP+RT patients. RP+RT was associated with a 18% lower rate of potency compared to RP alone, while RP+RT+ADT was associated with a further 17% reduction compared to RP+RT patients. Additional RT reduced QoL by 10% and additional ADT by a further 12% compared to RP only and RP+RT patients, respectively. The timing of RT after RP showed no influence on continence, but adjuvant compared to salvage RT was associated with significantly lower potency (37% vs 45%), but higher QoL (60% vs 56%).

Conclusions

Secondary RT and ADT after RP have an additive negative influence on urinary function, potency, and Qol. High-risk patients should be counseled on the potential net impairment in functional outcomes from multimodality treatment prior to RP.

Funding

none