Association Between Receipt of Definitive Treatment for Localized Prostate Cancer and Adverse Health Outcomes: A Claims-Based Approach

This study aimed to examine adverse health outcomes associated with receipt of definitive treatments (prostatectomy, intensity-modulated radiation therapy [IMRT] and brachytherapy). We identified men aged 65 years and older who received a new diagnosis of localized prostate cancer from 4 state cancer registries (CA, FL, NJ, and TX) during the years 2006 to 2013. We merged the registry records for this cohort with Medicare enrollment and claims. We constructed indicators of treatment-related adverse outcomes using diagnosis codes reported on the claims. Stage 1 models the choice of definitive treatment versus active surveillance. Stage 2 examines the probability of experiencing a treatment-related adverse health outcome among men who chose definitive treatment. Notably, 81.4% of our cohort of 61 187 men received definitive treatment whereas 18.6% were monitored with active surveillance. The 5-year prostate cancer death rate was 0.28% to 1.75% irrespective of treatment received. Men monitored with active surveillance experienced minimal adverse health outcomes (0.16%-0.75%). The risks of urinary incontinence associated with prostatectomy were 31 and 39.5 percentage points higher than brachytherapy and IMRT, respectively. For erectile dysfunction, the risks were nearly 23 and 27.5 percentage points higher, respectively, than brachytherapy and IMRT. Prostatectomy was associated with lower risk of urinary dysfunction and bowel dysfunction than either brachytherapy or IMRT. Compared with brachytherapy, IMRT was associated with a lower risk of erectile dysfunction (32%), urinary incontinence (84%), and urinary dysfunction (30%). This evidence should be of value to patient-physician decision making regarding the choice of definitive treatments versus active surveillance for men with localized disease. •Contemporary definitive (aggressive) treatments for prostate cancer include robotic prostatectomy, brachytherapy, and intensity-modulated radiation therapy (IMRT). Alternatively, for men with localized disease, the condition is sometimes managed through monitoring with active surveillance. Nevertheless, much of the available evidence does not model selection of aggressive treatment versus monitoring, examines homogeneous populations and older treatment technologies, and often does not include a comparison of definitive treatment to active surveillance.•In this large racially diverse population-based cohort of 49 796 men who received definitive treatment, receipt of