Prostatectomy and radiotherapy; what complications to expect

This article investigated complications other than urinary incontinence or erectile dysfunction associated with radiotherapy and radical prostatectomy treatments for prostate cancer.

For patients with localized (confined to the prostate gland) prostate cancer, the treatment options include radical prostatectomy (surgical removal of the prostate) or radiotherapy (applying radiation to kill malignant tumor cells). The two well-described side effects of both treatments are urinary incontinence and erectile dysfunction. However, other complications can ensue and compromise quality of life.  Other common complications are urinary tract obstruction, renal insufficiency and infections that necessitate hospital admission.

This article aimed to assess other harmful developments that might develop after these treatments. 

32,465 patients aged 18 and older with prostate cancer were included in this study. 15,870 patients underwent radical prostatectomy and 16,595 underwent radiotherapy. Patients were selected to match the control group (no history of prostate cancer) for comparison. To compare each group, 5-year cumulative incidences of five treatment-related complications were measured. 5-year cumulative incidence refers to the number of new cases of a particular complication occurring within a period of five years within the treatment population.

Results showed that among patients who underwent surgery or radiotherapy, the 5-year cumulative incidences were 22.2% for admission to hospital (e.g. for urinary obstruction or genitourinary bleeding) versus 5% of controls.  32% of patients required a urological procedure (e.g. cystoscopy, examination of the urinary bladder with an endoscope) versus 13% of controls. 13.7% of patients required a rectal or anal procedure (e.g. endoscopy) versus 5.3% of controls.  0.9% of patients required an open surgical procedure (related to the urinary tract, rectum or anus) versus 0.5% of controls.

Patients who were treated with radiotherapy had fewer urological procedures than did those who had surgery, but had higher incidence of complications in the other four categories.

3% of the treatment groups developed a second primary malignancy (cancer that developed within a different organ and did not originate from the prostate) in years 5 – 9, with incidences higher in the radiotherapy patients (4.5%) than the prostatectomy patients (1.8%). The most common site was the gastrointestinal tract.  

In summary, there was a high incidence of treatment-related complications, and so risks and effectiveness of both types of treatment should be weighed in advance of deciding on a treatment option.  

The data for this study was drawn from administrative hospital databases. As such, the procedures might have been done for a cause other than treatment complications and the incidences could have been overestimated.