Patient-reported outcomes before treatment for localized prostate cancer: are there differences among countries? Data from the True North Global Registry
Authors: Garin O. , Kowalski C. , Zamora V. , Roth R. , Ferrer M. , Breidenbach C. , Pont A. , Belin T. R. , Elashoff D. , Wilhalme H. , Nguyen A. V. , Kwan L. , Pearman E. K. , Bolagani A. , Sampurno F. , Papa N. , Moore C. , Millar J. , Connor S. E. , Villanti P. , Litwin M. S. ,   True North Global Registry, Graham Ian , Kowalski Christoph , Litwin Mark S. , Millar Jeremy , Moore Caroline , Paich Kellie , Zeps Nikolajs , Connor Sarah E. , Nguyen Anissa V. , Krishnaprasad Krupa , Breen Sibilah , Brglevska Silvi , King Michelle , Avuzzi Barbara , Barocas Daniel , Briganti Alberto , Chang Peter , Ferrer Montse , Finelli Anthony , Foster Claire , Frydenberg Mark , Ghani Khurshid R. , Grummet Jeremy , Mark Stephen , Mirone Vincenzo , Mun Dong-ho , Nelson Colleen , Ng Anthony , Pryor David , Siu Steven , Stricker Phil , van Basten Jean-Paul , Vickers Andrew , Zachoval Roman 
Published: November 2023

Abstract
Introduction
Similar Patient-Reported Outcomes (PROs) at diagnosis for localized prostate cancer among countries may indicate that different treatments are recommended to the same profile of patients, regardless the context characteristics (health systems, medical schools, culture, preferences…). The aim of this study was to assess such comparison.

Methods
We analyzed the EPIC-26 results before the primary treatment of men diagnosed of localized prostate cancer from January 2017 onwards (revised data available up to September 2019), from a multicenter prospective international cohort including seven regions: Australia/New Zealand, Canada, Central Europe (Austria / Czech Republic / Germany), United Kingdom, Italy, Spain, and the United States. The EPIC-26 domain scores and pattern of three selected items were compared across regions (with Central Europe as reference). All comparisons were made stratifying by treatment: radical prostatectomy, external radiotherapy, brachytherapy, and active surveillance.

Results
The sample included a total of 13,483 men with clinically localized or locally advanced prostate cancer. PROs showed different domain patterns before treatment across countries. The sexual domain was the most impaired, and the one with the highest dispersion within countries and with the greatest medians’ differences across countries. The urinary incontinence domain, together with the bowel and hormonal domains, presented the highest scores (better outcomes) for all treatment groups, and homogeneity across regions.

Conclusions
Patients with localized or locally advanced prostate cancer undergoing radical prostatectomy, EBRT, brachytherapy, or active surveillance presented mainly negligible or small differences in the EPIC-26 domains before treatment across countries.
The results on urinary incontinence or bowel domains, in which almost all patients presented the best possible score, may downplay the baseline data role for evaluating treatments’ effects. However, the heterogeneity within countries and the magnitude of the differences found across countries in other domains, especially sexual, support the need of implementing the PRO measurement from diagnosis.