This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (334)  • Contact me when this article is cited  Related Content  • Related letter  • Related article  • Similar articles in JAMA  Topic Collections  • Urology  • Alert me on articles by topic

The Prostate Cancer Outcomes Study

Janet L. Stanford, PhD; Ziding Feng, PhD; Ann S. Hamilton, PhD; Frank D. Gilliland, MD; Robert A. Stephenson, MD; J. William Eley, MD; Peter C. Albertsen, MD; Linda C. Harlan, PhD; Arnold L. Potosky, PhD

JAMA. 2000;283:354-360.

Context  Patients with prostate cancer and their physicians need knowledge of treatment options and their potential complications, but limited data on complications are available in unselected population-based cohorts of patients.

Objective  To measure changes in urinary and sexual function in men who have undergone radical prostatectomy for clinically localized prostate cancer.

Design  The Prostate Cancer Outcomes Study, a population-based longitudinal cohort study with up to 24 months of follow-up.

Setting  Population-based cancer registries in 6 geographic regions of the United States.

Participants  A total of 1291 black, white, and Hispanic men aged 39 to 79 years who were diagnosed as having primary prostate cancer between October 1, 1994, and October 31, 1995, and who underwent radical prostatectomy within 6 months of diagnosis for clinically localized disease.

Main Outcome Measures  Distribution of and change in urinary and sexual function measures reported by patients at baseline and 6, 12, and 24 months after diagnosis.

Results  At 18 or more months following radical prostatectomy, 8.4% of men were incontinent and 59.9% were impotent. Among men who were potent before surgery, the proportion of men reporting impotence at 18 or more months after surgery varied according to whether the procedure was nerve sparing (65.6% of non–nerve-sparing, 58.6% of unilateral, and 56.0% of bilateral nerve–sparing). At 18 or more months after surgery, 41.9% reported that their sexual performance was a moderate-to-large problem. Both sexual and urinary function varied by age (39.0% of men aged <60 years vs 15.3%-21.7% of older men were potent at 18 months [P<.001]; 13.8% of men aged 75-79 years vs 0.7%-3.6% of younger men experienced the highest level of incontinence at 18 months [P = .03]), and sexual function also varied by race (38.4% of black men reported firm erections at 18 months vs 25.9% of Hispanic and 21.3% of white men; P = .001).

Conclusions  Our study suggests that radical prostatectomy is associated with significant erectile dysfunction and some decline in urinary function. These results may be particularly helpful to community-based physicians and their patients with prostate cancer who face difficult treatment decisions.

Author Affiliations: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center (Drs Stanford and Feng) and Department of Epidemiology, University of Washington (Dr Stanford), Seattle, Wash; Department of Preventive Medicine, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles (Drs Hamilton and Gilliland); New Mexico Tumor Registry, University of New Mexico Health Sciences Center, Albuquerque (Dr Gilliland); Utah Cancer Registry and Division of Urology, University of Utah School of Medicine, Salt Lake City (Dr Stephenson); Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta (Dr Eley); Division of Urology, University of Connecticut Health Sciences Center, Farmington (Dr Albertsen); National Cancer Institute, Division of Cancer Control and Prevention, Bethesda, Md (Drs Harlan and Potosky).

RELATED LETTER

Genitourinary Consequences of Radical Prostatectomy
Steven D. Rockoff and Bradley R. Hennenfent
JAMA. 2000;283(22):2932.
EXTRACT | FULL TEXT  

RELATED ARTICLE

January 19, 2000
JAMA. 2000;283(3):411-412.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Management of Complications of Prostate Cancer Treatment
Michaelson et al.
CA Cancer J Clin 2008;58:196-213.
ABSTRACT | FULL TEXT  

Physical and Emotional Predictors of Depression After Radical Prostatectomy
Weber et al.
American Journal of Men's Health 2008;2:165-171.
ABSTRACT  

What is needed for informed decisions about prostate cancer screening: perspectives of African-American and Hispanic men
McFall et al.
Health Educ Res 2008;0:cyn018v1-cyn018.
ABSTRACT | FULL TEXT  

Quality of Life and Satisfaction with Outcome among Prostate-Cancer Survivors
Sanda et al.
NEJM 2008;358:1250-1261.
ABSTRACT | FULL TEXT  

The top 13: What family physicians should know about prostate cancer
Katz and Katz
cfp 2008;54:198-203.
ABSTRACT | FULL TEXT  

Decision Analyses in Consideration of Treatment Strategies for Patients with Biochemical Failure After Curative Therapy on Clinically Localized Prostate Cancer in the Prostate-Specific Antigen Era
Shimizu et al.
Jpn J Clin Oncol 2007;0:hym105v1-12.
ABSTRACT | FULL TEXT  

A Review and Meta-Analysis of Prostate Cancer Utilities
Bremner et al.
Med Decis Making 2007;27:288-298.
ABSTRACT  

Commentary: Prostate cancer is omnipresent, but should we screen for it?
Martin
Int J Epidemiol 2007;36:278-281.
FULL TEXT  

PSA Screening Among Elderly Men With Limited Life Expectancies.
Walter et al.
JAMA 2006;296:2336-2342.
ABSTRACT | FULL TEXT  

PSA Testing: Public Policy or Private Penchant?
Albertsen
JAMA 2006;296:2371-2373.
FULL TEXT  

Assessing Benefit and Risk in the Prevention of Prostate Cancer: The Prostate Cancer Prevention Trial Revisited
Klein et al.
JCO 2005;23:7460-7466.
ABSTRACT | FULL TEXT  

30-Day Mortality and Major Complications after Radical Prostatectomy: Influence of Age and Comorbidity
Alibhai et al.
JNCI J Natl Cancer Inst 2005;97:1525-1532.
ABSTRACT | FULL TEXT  

Prostate-Specific Antigen Levels in the United States: Implications of Various Definitions for Abnormal
Welch et al.
JNCI J Natl Cancer Inst 2005;97:1132-1137.
ABSTRACT | FULL TEXT  

Achieving Optimal Outcomes After Radical Prostatectomy
Saranchuk et al.
JCO 2005;23:4146-4151.
ABSTRACT | FULL TEXT  

Long-Term Outcomes Among Localized Prostate Cancer Survivors: Health-Related Quality-of-Life Changes After Radical Prostatectomy, External Radiation, and Brachytherapy
Miller et al.
JCO 2005;23:2772-2780.
ABSTRACT | FULL TEXT  

Designing the Selenium and Vitamin E Cancer Prevention Trial (SELECT)
Lippman et al.
JNCI J Natl Cancer Inst 2005;97:94-102.
ABSTRACT | FULL TEXT  

Shared Medical Decision Making: Problems, Process, Progress
McNutt
JAMA 2004;292:2516-2518.
FULL TEXT  

Racial/Ethnic Differences in Functional Outcomes in the 5 Years After Diagnosis of Localized Prostate Cancer
Johnson et al.
JCO 2004;22:4193-4201.
ABSTRACT | FULL TEXT  

Health-Related Quality of Life, Satisfaction, and Economic Outcome Measures in Studies of Prostate Cancer Screening and Treatment, 1990-2000
McNaughton-Collins et al.
J Natl Cancer Inst Monogr 2004;2004:78-101.
ABSTRACT | FULL TEXT  

Assessing Cancer-Related Quality of Life Across a Spectrum of Applications
Gotay
J Natl Cancer Inst Monogr 2004;2004:126-133.
ABSTRACT | FULL TEXT  

Five-Year Outcomes After Prostatectomy or Radiotherapy for Prostate Cancer: The Prostate Cancer Outcomes Study
Potosky et al.
JNCI J Natl Cancer Inst 2004;96:1358-1367.
ABSTRACT | FULL TEXT  

Case 21-2004 - A 63-Year-Old Man with Metastatic Prostate Carcinoma Refractory to Hormone Therapy
Kaufman et al.
NEJM 2004;351:171-178.
FULL TEXT  

In Reply:
Penson and Stanford
JCO 2003;21:4655-4656.
FULL TEXT  

Caring for a Spouse after Prostate Surgery: The Preparedness Needs of Wives
Giarelli et al.
Journal of Family Nursing 2003;9:453-485.
ABSTRACT  

Time Course and Predictors of Symptoms After Primary Prostate Cancer Therapy
Talcott et al.
JCO 2003;21:3979-3986.
ABSTRACT | FULL TEXT  

Patients' Perceptions of Quality of Life After Treatment for Early Prostate Cancer
Clark et al.
JCO 2003;21:3777-3784.
ABSTRACT | FULL TEXT  

Polymorphisms of Prostate-Specific Antigen Gene Promoter: Determination From Cord Blood Collected on Filter Paper
Liu et al.
Annals of Clinical & Laboratory Science 2003;33:429-434.
ABSTRACT | FULL TEXT  

Annual Report to the Nation on the Status of Cancer, 1975-2000, Featuring the Uses of Surveillance Data for Cancer Prevention and Control
Weir et al.
JNCI J Natl Cancer Inst 2003;95:1276-1299.
ABSTRACT | FULL TEXT  

Do Older Men Benefit From Curative Therapy of Localized Prostate Cancer?
Alibhai et al.
JCO 2003;21:3318-3327.
ABSTRACT | FULL TEXT  

Why do Primary Care Physicians in the United States and France Order Prostate-Specific Antigen Tests for Asymptomatic Patients?
Sorum et al.
Med Decis Making 2003;23:301-313.
ABSTRACT  

An Argument Against Routine Prostate Cancer Screening
Hoffman
Arch Intern Med 2003;163:663-665.
FULL TEXT  

Rebuttal by Dr Hoffman
Hoffman
Arch Intern Med 2003;163:666-666.
FULL TEXT  

Predictors of Biochemical Outcome With Salvage Conformal Radiotherapy After Radical Prostatectomy for Prostate Cancer
Katz et al.
JCO 2003;21:483-489.
ABSTRACT | FULL TEXT  

Screening for Prostate Cancer: An Update of the Evidence for the U.S. Preventive Services Task Force
Harris and Lohr
ANN INTERN MED 2002;137:917-929.
ABSTRACT | FULL TEXT  

A Randomized Trial Comparing Radical Prostatectomy with Watchful Waiting in Early Prostate Cancer
Holmberg et al.
NEJM 2002;347:781-789.
ABSTRACT | FULL TEXT  

Quality of Life after Radical Prostatectomy or Watchful Waiting
Steineck et al.
NEJM 2002;347:790-796.
ABSTRACT | FULL TEXT  

Overdiagnosis Due to Prostate-Specific Antigen Screening: Lessons From U.S. Prostate Cancer Incidence Trends
Etzioni et al.
JNCI J Natl Cancer Inst 2002;94:981-990.
ABSTRACT | FULL TEXT  

Selling sickness: the pharmaceutical industry and disease mongering * Commentary: Medicalisation of risk factors
Moynihan et al.
BMJ 2002;324:886-891.
FULL TEXT  

Variations in Morbidity after Radical Prostatectomy
Begg et al.
NEJM 2002;346:1138-1144.
ABSTRACT | FULL TEXT  

Androgen Deprivation as Primary Treatment for Early Prostate Cancer: Should We "Just Do Something"?
Talcott
JNCI J Natl Cancer Inst 2002;94:407-409.
FULL TEXT  

Comprehensive Comparison of Health-Related Quality of Life After Contemporary Therapies for Localized Prostate Cancer
Wei et al.
JCO 2002;20:557-566.
ABSTRACT | FULL TEXT  

Factors Associated With Initial Therapy for Clinically Localized Prostate Cancer: Prostate Cancer Outcomes Study
Harlan et al.
JNCI J Natl Cancer Inst 2001;93:1864-1871.
ABSTRACT | FULL TEXT  

Effect of sex and gender on psychosocial aspects of prostate and breast cancer
Kiss and Meryn
BMJ 2001;323:1055-1058.
FULL TEXT  

Measuring patients' preferences for treatment and perceptions of risk
Bowling and Ebrahim
Qual Saf Health Care 2001;10:i2-8.
FULL TEXT  

Informed consent: moral necessity or illusion?
Doyal
Qual Saf Health Care 2001;10:i29-33.
ABSTRACT | FULL TEXT  

Health Outcomes After External-Beam Radiation Therapy for Clinically Localized Prostate Cancer: Results From the Prostate Cancer Outcomes Study
Hamilton et al.
JCO 2001;19:2517-2526.
ABSTRACT | FULL TEXT  

Health-Related Quality-of-Life Effects of Radical Prostatectomy and Primary Radiotherapy for Screen-Detected or Clinically Diagnosed Localized Prostate Cancer
Madalinska et al.
JCO 2001;19:1619-1628.
ABSTRACT | FULL TEXT  

RESPONSE: Re: Health Outcomes After Prostatectomy or Radiotherapy for Prostate Cancer: Results From the Prostate Cancer Outcomes Study
Potosky et al.
JNCI J Natl Cancer Inst 2001;93:401a-402a.
FULL TEXT  

Comparative Efficiency of Prostate-Specific Antigen Screening Strategies for Prostate Cancer Detection
Ross et al.
JAMA 2000;284:1399-1405.
ABSTRACT | FULL TEXT  

Comparison of Recommendations by Urologists and Radiation Oncologists for Treatment of Clinically Localized Prostate Cancer
Fowler et al.
JAMA 2000;283:3217-3222.
ABSTRACT | FULL TEXT  

Uncertainty in Prostate Cancer Care: The Physician's Role in Clearing the Confusion
Wilt
JAMA 2000;283:3258-3260.
FULL TEXT  

Genitourinary Consequences of Radical Prostatectomy
Rockoff and Hennenfent
JAMA 2000;283:2932-2932.
FULL TEXT  

Sexual Dysfunction and Urinary Incontinence After Prostatectomy
JWatch Psychiatry 2000;2000:20-20.
FULL TEXT  

Sexual Dysfunction and Urinary Incontinence After Prostatectomy
JWatch General 2000;2000:1-1.
FULL TEXT