The New Standard: Personalised Information about the Risks and Benefits of Treatment Strategies for Localised Prostate Cancer

In this month's issue of European Urology, Tyson et al. [1] described whether differences in patient-reported functional outcomes between patients who received radical prostatectomy (RP, n = 1291) and external beam radiotherapy (EBRT, n = 662) varied by localised prostate cancer (PCa) risk group. Among the patients who participated in this large longitudinal, population-based, prospective study (Comparative Effectiveness Analysis of Surgery and Radiation [CEASAR]), 39% had low-risk disease, 43% had intermediate-risk disease, and 19% high-risk disease. The authors reported a clinically significant interaction effect between treatment and PCa risk group for sexual function. That is, in patients who received RP, sexual function 3 yr following treatment was significantly more favourable in patients who had low-risk PCa than in those with high-risk PCa (mean [95% confidence interval {CI}], low-risk = 39 [37–42], high-risk = 32 [28–35]; p < 0.001; proportion of patients who reported sexual dysfunction: low-risk = 65%, high-risk = 78%). This difference was, however, not classified as clinically relevant (ie, a difference of ten points or more). In patients who received EBRT, the difference between patients with low-risk and high-risk PCa was classified as clinically relevant (low-risk = 52 [95% CI, 47–56]; high-risk = 38 [33–42]; p < 0.001; proportion of patients who reported sexual dysfunction: low-risk = 67%, high-risk = 82%). Unlike sexual function, cancer severity did not significantly modify the effect of treatment on urinary incontinence, hormone, bowel, and urinary irritaive domains. Therefore, the authors conclude that patients with high-risk tumours should be counselled differently about possible sexuality-related quality of life outcomes than patients with low-risk PCa.