Additional surgical intervention after radical prostatectomy, radiation therapy, androgen-deprivation therapy, or watchful waiting

Objectives: The amount of additional surgical procedures that cancer patients undergo following their initial treatment is one means of measuring the impact that cancer and cancer treatment has on their quality of life. In this study we looked for treatment-related differences in the need for additional surgical intervention among men with nonmetastatic prostate cancer within 66 mo of their initial treatment. Methods: Data for this study were from the National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) program and from the Medicare claims database. We searched the claims database for procedure codes indicating artificial urinary sphincter procedures, cystoscopy, urethral dilation, transurethral resection of the prostate (TURP) and bladder-neck incision, bladder irrigation/cystotomy, or nephrostomy. Results: Of the 12,711 patients in our study, 3940 (31.0%) were initially treated by radical prostatectomy (RP), 3950 (31.1%) by radiation therapy (RT), 1209 (9.5%) by androgen- deprivation therapy (ADT), and 3612 (28.4%) by watchful waiting (WW). The percentage of patients who underwent cystoscopy 6-66 mo after their initial treatment ranged narrowly from 22% to 24% among members of the four treatment groups. In the RP group, 5.2% had artificial urinary sphincter procedures; 6.8% of the RT group, 8.2% of the ADT group, and 10.1% of the WW group had TURP/bladder- neck procedures compared with 3.7% of the RP group; and 12.5-16.2% of members in the four groups had urethral dilation procedures. Conclusions: Over one third of prostate cancer patients needed surgical intervention within 66 mo of their initial treatment despite the type of initial treatment.