Moving the surgical prostate cancer treatment to value: Early results in patient-reported outcomes from a Brazilian cohort.

Abstract

e13601 Background: Prostate cancer (PCa) is the most frequently diagnosed malignancy among men in Brazil. While therapeutic advances have reduced mortality in high and intermediate-risk disease, functional sequelae such as urinary incontinence and erectile dysfunction remain highly prevalent in several patients. Value-based healthcare (VBHC) programs, centered on patient-reported outcomes (PROMs) and integrated care pathways, have emerged as a strategy to optimize care delivery and align clinical results with outcomes that matter to patients, but evidence of their structure and implementation in Brazil is scarce. This study reports early results from a value-based program for the surgical treatment of PCa in Brazil. Methods: Since 2022, a strategic value-based healthcare program has supported each cancer center with accurate real-world data and used it to deliver effective patient-centered care. PROMs have been collected using the ICHOM-recommended EPIC-CP instrument at baseline, 90 days, and 365 days. Outcomes included urinary continence, sexual function, and adherence to rehabilitation strategies. Clinical and demographic data were integrated with PROMs to assess functional recovery trajectories. In this early results report, the analyses are descriptively presented and compared over the period through the Cochran test for each outcome. Results: From August 2022 to April 2025, 535 patients were enrolled in the institutional value program, of whom 346 underwent radical prostatectomy. A subset of 118 patients completed all timepoints and composed the sample for this early results cohort. The mean age was 63.6 (SD = 8.1) years, with 79% undergoing robotic-assisted prostatectomy. At one year, 76% of patients maintained pre-treatment urinary function, with 78% of non-elderly and 74% of elderly patients reporting no pad use. Table 1 contains the results. Sexual function recovery was heterogeneous: among previously potent patients, 34% (≤65 years) and 21% (≥66 years) reported erections firm enough for intercourse at one year. Sexual rehabilitation interventions (PDE5 inhibitors, intracavernosal therapy, vacuum devices) were associated with significant improvements compared to no therapy (p = 0.033), and contributed to more than 90% of patients keeping or improving their sexual function in one year. Program adherence was high, with response rates of 84.5% at 90 days and 83% at 365 days. Conclusions: The PCa Value Program demonstrates that structured PROM collection and integrated care and rehabilitation strategies can achieve functional outcomes comparable to international benchmarks, despite resource constraints in Brazil. By embedding VBHC principles into oncology, the program highlights the feasibility of patient-centered, outcome-driven cancer care in Latin America.