JU INSIGHT: Patient-reported Outcomes After External Beam Radiotherapy With Low Dose Rate Brachytherapy Boost vs Radical Prostatectomy for Localized Prostate Cancer: Five-year Results From a Prospective Comparative Effectiveness Study

By: Brian De, MD; Dario Pasalic, MD; Daniel A. Barocas, MD, MPH; Christopher J. D. Wallis, MD, PhD; Li-Ching Huang, PhD; Zhiguo Zhao, MS; Tatsuki Koyama, PhD; Chad Tang, MD; Michael Goodman, MD, MPH; Ann S. Hamilton, PhD; Xiao-Cheng Wu, MD; Lisa E. Paddock, PhD; Antoinette Stroup, PhD; Matthew R. Cooperberg, MD, MPH; Mia Hashibe, PhD; Brock B. O'Neil, MD; Sherrie H. Kaplan, PhD, MS, MPH; Sheldon Greenfield, MD; David F. Penson, MD, MPH; Karen E. Hoffman, MD, MHSc, MPH | Posted on: 01 Dec 2022

De B, Pasalic D, Barocas DA, et al. Patient-reported outcomes after external beam radiotherapy with low dose rate brachytherapy boost vs radical prostatectomy for localized prostate cancer: five-year results from a prospective comparative effectiveness study. J Urol. 2022;208(6):1226-1239.

Study Need and Importance

For the treatment of localized prostate cancer, high-quality data comparing radical prostatectomy (RP) and external beam radiation therapy with low dose rate brachytherapy boost (EBRT-LDR) are lacking. To better guide shared decision making regarding treatment, we compared patient reported outcomes through 5 years following RP or EBRT-LDR. Men with localized prostate cancer were enrolled in Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR), a multisite prospective study that captured patient reported outcomes through surveys at baseline, 6 months, and 1, 3, and 5 years.

What We Found

EBRT-LDR was associated with clinically meaningful worse bowel and worse urinary irritative/obstructive function and RP was associated with worse urinary incontinence function through 5 years (see Figure). Despite these differences, however, urinary function bother was similar between groups. Treatment with EBRT-LDR was associated with worse bowel function through 5 years compared to RP. Treatment with EBRT-LDR was associated with better sexual function at 1 year compared to RP, but sexual function was no different at 3 or 5 years.


This is a retrospective, observational study, which limits our ability to draw causal relationships. Treatment choice is nonrandom, which can lead to confounding. Missing survey data, particularly if not missing at random, may contribute to bias. Patients treated with EBRT-LDR received heterogeneous doses, fractionations, and techniques, which may limit generalizability to a contemporary cohort. Finally, this study considers data through 5 years following treatment, which is expected to capture the majority of functional change a patient may experience; however, it is possible that the data may insufficiently capture late effects.

Interpretation for Patient Care

Patient-reported functional outcomes differed considerably between patients who received RP or EBRT-LDR. These data may clarify treatment expectations and help men make informed treatment choices for their localized prostate cancer.