Podium Session

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PD09-03: Three-year functional outcomes after radiation, surgery or observation for localized prostate cancer in the CEASAR study

Friday, May 12
1:20 PM - 1:30 PM
Location: BCEC: Room 161

Presentation Authors: Daniel Barocas*, JoAnn Alvarez, Matthew Resnick, Tatsuki Koyama, Mark Tyson, Nashville, TN, Karen Hoffman, Houston, TX, David Penson, Nashville, TN

Introduction: Prostate cancer (PCa) treatments are associated with urinary, sexual, and bowel side effects. Previous comparative effectiveness studies are limited by narrow inclusion criteria and outmoded treatments. Herein, we present 3-year functional outcomes in a diverse population of patients receiving contemporary treatment for localized PCa.



Methods: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based, cohort study of men diagnosed with localized PCa in 2011-2012. Men 80 years old or younger, with newly diagnosed cT1 or cT2 PCa, prostate specific antigen less than 50 ng/dL, were accrued from five Surveillance Epidemiology, and End Results (SEER) registry sites and from the Cancer of the Prostate Strategic Urologic Research Endeavor. Patient-reported urinary, sexual and bowel function, using the 26-item Expanded Prostate Index Composite (EPIC) at baseline, 6, 12, and 36 months after enrollment (range 0-100, higher score indicates better function).



Results: The analytic cohort contained 2,543 men: 26% non-white; 45% low-risk, 39% intermediate risk, 16% high risk. 1,523 (59.9%) men underwent radical prostatectomy (RP), 599 (23.6%) external beam radiotherapy (EBRT), and 421 (16.6%) active surveillance (AS). At 3 years, sexual function after RP was significantly worse than EBRT (-17.1 points; 95% CI: -21.7 to -12.6; p<0.001), Figure. Differences in sexual function between EBRT and AS at 3 years, while statistically significant, were not clinically significant (-5.9 points; 95% CI -11.0 to -0.8; p=0.023). RP was associated worse urinary continence scores than EBRT (-18 points; 95%CI: -20.6, -15.5; p<0.001) or AS (-13.4 points; 95% CI: -16.8, -10.1; p<0.001). At 3 years, 14% of RP men reported moderate or big problem with urinary leakage compared to 5% for EBRT and 6% for AS (p<0.001). Functional outcomes were driven largely by baseline function and treatment (Figure). There were no clinically significant differences in bowel or hormone function and no difference in survival.



Conclusions: The effects of modern treatments are similar to the effects of older modalities noted in prior studies. This information will provide a foundation for shared decision making, rooted in contemporary population-based data.



Source Of Funding: Funding for the study was provided by Agency for Healthcare Research and Quality (1R01HS019356, 1R01HS022640); Patient-Centered Outcomes Research Institute (CE-12-11-4667); Vanderbilt Institute of Clinical and Translational Research (UL1TR000011 from NCAT

Daniel A. Barocas, MD, MPH, FACS

Vanderbilt University Medical Center

Daniel A. Barocas, MD, MPH, FACS is Associate Professor of Urologic Oncologiy at the Vanderbilt University Medical Center, and the Vanderbilt Ingraham Cancer Center. He has clinical and research interests in urologic cancers, particularly in the detection and treatment of localized cancers, and the measurement of patient outcomes and quality of care. He is co-director of the Center for Surgical Quality and Outcomes research, an intellectual home for surgeon scientists at VUMC. Dr. Barocas has received grants from NIH to study active surveillance for prostate cancer care, and to study variation in the evaluation of hematuria. He is currently co-PI of the CEASAR study (Comparative Effectiveness Assessment of Surgery And Radiation), funded by AHRQ to study patient-reported outcomes in a large prospective, population-based cohort study. In addition to his activities as a urologic oncologist and health services researcher, Dr. Barocas is involved with national organizations, including the American Urological Association and Commission on Cancer, in development of quality measures for urologic cancer care, and serves as an assistant editor for the Journal of Urology.

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PD09-03: Three-year functional outcomes after radiation, surgery or observation for localized prostate cancer in the CEASAR study



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