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Prostate volume, baseline urinary function, and their association with treatment choice and post-treatment urinary function in men treated for localized prostate cancer

Prostate Cancer and Prostatic Diseases volume 26, pages 787–794 (2023)Cite this article

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A Correction to this article was published on 08 March 2023

This article has been updated

Abstract

Background

Benign prostatic hyperplasia, lower urinary tract symptoms, and prostate cancer often co-occur. Their effect on urinary function is an important consideration regarding prostate cancer treatment choices. While prostate volume (PV) and urinary symptoms are commonly used in treatment choice decision making, their association with post-treatment urinary function is unknown. We evaluated the associations between PV and baseline urinary function with treatment choice and post-treatment urinary function among men with localized prostate cancer.

Methods

We identified 1647 patients from CEASAR, a multicenter population-based, prospective cohort study of men with localized prostate cancer, for analysis. Primary outcomes were treatment choice and health-related quality of life (HRQOL) assessed by the 26-item Expanded Prostate Index Composite (EPIC-26) at pre-specified intervals up to 5 years. Multivariable analysis was performed, controlling for demographic and clinicopathologic features.

Results

Median baseline PV was 36 mL (IQR 27–48), and baseline urinary irritative/obstructive domain score was 87 (IQR 75–100). There was no observed clinically meaningful association between PV and treatment choice or post-treatment urinary function. Among patients with poor baseline urinary function, treatment with radiation or surgery was associated with statistically and clinically significant improvement in urinary function at 6 months which was durable through 5 years (improvement from baseline at 5 years: radiation 20.4 points, surgery 24.5 points).

Conclusions

PV was not found to be associated with treatment modality or post-treatment urinary irritative/obstructive function among men treated for localized prostate cancer. Men with poor baseline urinary irritative/obstructive function improve after treatment with surgery or radiation therapy.

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Fig. 1: Multivariable model predicted urinary irritative/obstructive domain score stratified by baseline urinary irritative/obstructive function and treatment choice.
Fig. 2: Longitudinal EPIC-26 urinary irritative/obstructive domain score stratified by baseline urinary function, prostate volume, and treatment choice.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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References

  1. Bostwick DG, Cooner WH, Denis L, Jones GW, Scardino PT, Murphy GP. The association of benign prostatic hyperplasia and cancer of the prostate. Cancer. 1992;70:291–301.

    Article  CAS  PubMed  Google Scholar 

  2. Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part II: recommended approaches and details of specific care options. J Urol. 2018;199:990–7.

    Article  PubMed  Google Scholar 

  3. Eastham JA, Auffenberg GB, Barocas DA, Chou R, Crispino T, Davis JW, et al. Clinically localized prostate cancer: AUA/ASTRO guideline, Part I: Introduction, Risk Assessment, Staging and Risk-Based Management. J Urol. 2022. https://doi.org/10.1097/JU.0000000000002757.

  4. Barocas DA, Penson DF. Functional recovery following primary treatment for prostate cancer: update from the CEASAR study. Eur Urol Focus. 2020;6:205–7.

    Article  PubMed  Google Scholar 

  5. Mendenhall NP, Rausch Osian SM, Bryant CM, Hoppe BS, Morris CG. What men want: results from a national survey on decision making for prostate cancer treatment and research participation. Clin Transl Sci. 2021; cts.13090.

  6. Barocas DA, Chen V, Cooperberg M, Goodman M, Graff JJ, Greenfield S, et al. Using a population-based observational cohort study to address difficult comparative effectiveness research questions: The CEASAR study. J Comp Eff Res. 2013;2:445–60.

    Article  PubMed  Google Scholar 

  7. Mandel P, Weinhold P, Michl U, Huland H, Graefen M, Tilki D. Impact of prostate volume on oncologic, perioperative, and functional outcomes after radical prostatectomy. Prostate. 2015;75:1436–46.

    Article  PubMed  Google Scholar 

  8. Ward NT, Parsons JK, Levinson AW, Bagga HS, Mettee LZ, Su L-M, et al. Prostate size is not associated with recovery of sexual function after minimally invasive radical prostatectomy. Urology. 2011;77:952–6.

    Article  PubMed  Google Scholar 

  9. Levinson AW, Bagga HS, Pavlovich CP, Mettee LZ, Ward NT, Link RE, et al. The impact of prostate size on urinary quality of life indexes following laparoscopic radical prostatectomy. J Urol. 2008;179:1818–22.

    Article  PubMed  Google Scholar 

  10. Szymanski KM, Wei JT, Dunn RL, Sanda MG. Development and validation of an abbreviated version of the expanded prostate cancer index composite instrument for measuring health-related quality of life among prostate cancer survivors. Urology. 2010;76:1245–50.

    Article  PubMed  Google Scholar 

  11. Skolarus TA, Dunn RL, Sanda MG, Chang P, Greenfield TK, Litwin MS, et al. Minimally important difference for the expanded prostate cancer index composite short form. Urology. 2015;85:101–6.

    Article  Google Scholar 

  12. Litwin MS, Greenfield S, Elkin EP, Lubeck DP, Broering JM, Kaplan SH. Assessment of prognosis with the total illness burden index for prostate cancer. Cancer. 2007;109:1777–83.

    Article  PubMed  Google Scholar 

  13. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.

    Article  Google Scholar 

  14. Radloff LS. The CES-D Scale. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  15. Kaplan SH, Gandek B, Greenfield S, Rogers W, Ware JE. Patient and visit characteristics related to physicians participatory decision-making style. Med Care. 1995;33:1176–87.

    Article  CAS  PubMed  Google Scholar 

  16. White H. A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica. 1980;48:817.

    Article  Google Scholar 

  17. Huber PJ. The behavior of maximum likelihood estimates under nonstandard conditions. In: Lecam L, Neyman J (eds). Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability. University of California Press, 1966, pp 221–34.

  18. White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011;30:377–99.

    Article  PubMed  Google Scholar 

  19. Schafer JL. Analysis of Incomplete Multivariable Data. 1st ed. Chapman and Hall CRC Press: London, UK, 1997.

  20. Simon RM, Howard LE, Moreira DM, Roehrborn C, Vidal AC, Castro-Santamaria R, et al. Does prostate size predict the development of incident lower urinary tract symptoms in men with mild to no current symptoms? Results from the REDUCE Trial. Eur Urol. 2016;69:885–91.

    Article  PubMed  Google Scholar 

  21. Crawford ED, Wilson SS, McConnell JD, Slawin KM, Lieber MC, Smith JA, et al. Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol. 2006;175:1422–7.

    Article  CAS  PubMed  Google Scholar 

  22. Vesely S, Knutson T, Damber J-E, Dicuio M, Dahlstrand C. Relationship between age, prostate volume, prostate-specific antigen, symptom score and uroflowmetry in men with lower urinary tract symptoms. Scand J Urol Nephrol. 2003;37:322–8.

    Article  PubMed  Google Scholar 

  23. Uberoi P, Smith CA, Lucioni A. Management of lower urinary tract symptoms after prostate radiation. Curr Urol Rep. 2021;22:37.

    Article  PubMed  Google Scholar 

  24. Masters JG, Rice ML. Improvement in urinary symptoms after radical prostatectomy: a prospective evaluation of flow rates and symptom scores. BJU Int. 2003;91:795–7.

    Article  CAS  PubMed  Google Scholar 

  25. Schwartz EJ, Lepor H. Radical retropubic prostatectomy reduces symptom scores and improves quality of life in men with moderate and severe lower urinary tract symptoms. J Urol. 1999;161:1185–8.

    Article  CAS  PubMed  Google Scholar 

  26. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N. Engl J Med. 2008;358:1250–61.

    Article  CAS  PubMed  Google Scholar 

  27. Teunissen FR, Willigenburg T, Meijer RP, van Melick HHE, Verkooijen HM, van der Voort van Zyp JRN. The first patient-reported outcomes from the Utrecht Prostate Cohort (UPC): the first platform facilitating ‘trials within cohorts’ (TwiCs) for the evaluation of interventions for prostate cancer. World J Urol. 2022;40:2205–12.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Pepin A, Pernia M, Danner MT, Ayoob M, Yung TM, Lei S, et al. Impact of age on patient-reported outcomes following stereotactic body radiation therapy for prostate cancer. Cureus. 2021. https://doi.org/10.7759/cureus.13780.

  29. Wang F, Luan Y, Fan Y, Huang T, Zhu L, Lu S, et al. Comparison of the oncological and functional outcomes of brachytherapy and radical prostatectomy for localized prostate cancer. Med (B Aires). 2022;58:1387.

    Google Scholar 

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Funding

AHRQ: 1R01HS019356, 1R01HS022640. PCORI: CE-12-11-4667. NIH/NCI: R01CA230352. NCATS/NIH: UL1TR000011.

Author information

Authors and Affiliations

  1. Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA

    Jacob E. Tallman, Christopher J. D. Wallis, David F. Penson & Daniel A. Barocas

  2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Zhiguo Zhao, Li-Ching Huang & Tatsuki Koyama

  3. Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA

    Michael Goodman

  4. Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA

    Ann S. Hamilton

  5. Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA, USA

    Xiao-Cheng Wu

  6. Department of Epidemiology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Lisa E. Paddock & Antoinette Stroup

  7. Department of Urology, University of California, San Francisco, CA, USA

    Matthew R. Cooperberg

  8. Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Mia Hashibe

  9. Department of Urology, University of Utah Health, Salt Lake City, UT, USA

    Brock B. O’Neil

  10. Department of Medicine, University of California Irvine, Irvine, CA, USA

    Sherrie H. Kaplan & Sheldon Greenfield

  11. Department of Radiation Oncology, University of Texas M. D. Anderson Center, Houston, TX, USA

    Karen E. Hoffman

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  1. Jacob E. Tallman
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Contributions

JET, MD: 1,3,4,5,6. CJDW, MD, PhD, FRCSC: 1,3,4,5,6. ZZ, MS: 1,3,5,6. L-CH, PhD: 1,3,5,6. DFP, MD, MPH: 1,2,5,6. TK, PhD: 1,3,5,6. MG, MD, MPH: 1,2,5,6. ASH, PhD, MA: 1,2,5,6. X-CW, MD, MPH: 1,2,5,6. LEP, PhD, MPH: 1,2,5,6. AS, PhD: 1,2,5,6. MRC, MD, MPH: 1,2,5,6. MH, PhD:1,2,5,6. BBO’N, MD: 1,2,5,6. SHK, PhD, MS, MPH: 1,2,5,6. SG, MD: 1,2,5,6. KEH, MD, MHSc, MPH: 1,2,5,6. DAB, MD, MPH: 1,2,3,4,5,6. (1) Conception or design of the work. (2) Data collection. (3) Data analysis and interpretation. (4) Drafting the article. (5) Critical revision of the article. (6) Final approval of the version to be published.

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Correspondence to Jacob E. Tallman.

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The original online version of this article was revised: In this article the statement in the Funding information section was incorrectly given as '5T32CA106183' and has been deleted. The original article has been corrected.

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Tallman, J.E., Wallis, C.J.D., Zhao, Z. et al. Prostate volume, baseline urinary function, and their association with treatment choice and post-treatment urinary function in men treated for localized prostate cancer. Prostate Cancer Prostatic Dis 26, 787–794 (2023). https://doi.org/10.1038/s41391-022-00627-1

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