Delineating the Long-Term Incidence of Urethral Complications After Prostate Cancer Treatment: A Population-Based Analysis.

PURPOSE: Despite robust 15-year cancer-specific survival for localized prostate cancer (CaP), long-term urethral complications after treatment are sparsely reported. Our objective is to assess the long-term incidence of urethral complications after CaP treatment. MATERIALS AND METHODS: Men with the diagnosis of CaP from 2002 to 2021 in the Alberta Cancer Registry were evaluated for complications using Discharge Abstract Data and National Ambulatory Care Reporting System. Urethral complications were defined as development of stenosis, fistula, or a urethral procedure > 30 days after treatment. Patients were allocated into 8 treatment groups, radical prostatectomy (RP), external beam radiotherapy (EBRT), brachytherapy (BT), cryotherapy (Cryo), RP + EBRT, EBRT + BT, Cryo + EBRT, or medical treatment/observation (MT/O). Urethral complications were compared between groups using Cox regression. RESULTS: A total of 47,387 patients were identified with a median age of 66 years (IQR 14). At a median follow-up of 79 months (P25 = 36, P75 = 140), 3140 patients developed urethral complications. On multivariable Cox regression, age (P < .001), stage (P = .001), and treatment modality (P < .001) were independently associated with urethral complications. Most treatment modalities were associated with development of complications when compared with MT/O. The 15-year incidence of urethral complications were the highest for combined modalities. EBRT + Cryo (42%), EBRT + BT (26%), and RP + EBRT (22%) were at the highest risk while MT/O (8%) and RP (9%) were at the lowest. Complications after RP plateaued at 10 years, whereas other modalities continued to accumulate complications over time. CONCLUSIONS: Patients undergoing CaP treatment are at a risk of developing urethral complications in the long-term regardless of treatment modality. However, combined modalities pose a heightened risk while observation and radical prostatectomy have the lowest with complications from surgery appearing earlier and stabilizing over time.