EURURO Vol. 72 No. 6

urinary irritation/obstruction scores, but with reduced QoL

related to bowel function and vitality. Patients treated with

EBRT plus ADT also reported CSD in sexual function.

Surprisingly, patients in the BT group reported significant

reductions in all QoL subdomain scores except vitality.

3.4.2.2. RP versus EBRT or AS.

Four studies

[23,24,26,28–30]

reported QoL outcomes in men with localised PCa

undergoing RP or EBRT; however, in one

[29]

, authors did

not compare differences in QoL scores between treatments.

In the most recent update of the Prostate Cancer Outcomes

Study (PCOS)

[26]

, the authors compared QoL scores at 2, 5,

and 15 yr after primary therapy. Although men undergoing

RP had significantly higher rates of incontinence and

erectile dysfunction and lower rates of bowel urgency at

2 and 5 yr, these rates were similar to those in the EBRT

group at 15 yr. Barocas et al

[30]

using the EPIC

questionnaire, reported that RP was associated with a

greater decrease in sexual function and urinary inconti-

nence than EBRT at 3 yr of follow-up. No clinically

meaningful differences existed in bowel function beyond

12 mo. The fourth study

[28]

had a limited follow-up and

reported that men who underwent RP experienced signifi-

cant declines in urinary and sexual function when

compared with EBRT.

Regarding comparison of QoL outcomes between RP and

AS, Jeldres et al

[17]

in a cohort of patients with low-risk PCa

reported similar results to ProtecT trial

[12]

, as at 3 yr of

follow-up, patients who underwent surgery had signifi-

cantly poorer urinary, sexual function, and sexual bother

scores.

3.4.2.3. BT versus RP or EBRT.

Four studies assessed QoL

outcomes in patients with localised PCa after BT or RP

[15,18–20]

. Investigators in two studies

[18,20]

included a

small number of patients with a limited follow-up of 12 mo

[(Fig._2)TD$FIG]

Fig. 2 – Risk of bias and confounder assessment for (A) RCTs and (B) nonrandomised prospective studies. Red colour indicates high RoB, yellow

uncertain RoB, and green low RoB. RCT = randomised controlled trial; RoB = risk of bias.

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 8 6 9 – 8 8 5

878