New QOL study on AS, Surgery, EBRT and Seeds

From the North Carolina Central Cancer Registry on 1,141 men. The conclusions were in-line with the 2016 ProtecT trial but I found the detail better presented.

For example:

For men who reported normal baseline sexual function, 57.1% reported poor function at 24months after prostatectomy, 27.2% after external beam radiotherapy, 34.2% after brachytherapy, and 25.2% after active surveillance.

For men who reported normal baseline urinary irritation and obstruction, 8.1% reported poor function at 24months after prostatectomy, 15.4% after external beam radiotherapy, 23.9% after brachytherapy, and 13.2% after active surveillance.

For men who reported normal baseline incontinence, 15.8% reported poor function at 24months after prostatectomy, 7.1% after external beam radiotherapy, 9.0% after brachytherapy, and 7.0% after active surveillance.

For men who reported normal baseline bowel problems, 5.6% reported poor function at 24months after prostatectomy, 17.4% after external beam radiotherapy, 8.9% after brachytherapy, and 9.3% after active surveillance.

Some comments:
I'm not sure how AS reduces any of these functions unless its either being 24 months older or the repeated biopsies (ouch) do something.

It does seem that sexual function declines for everyone quite a bit over 24 months even if you are on AS, but surgery really puts a dampener on things. Not sure why brachy was worse for sexual function than EBRT??

As most surgery patients know, removing the prostate improves obstruction dramatically so no surprise there

Incontinence was clearly worse for surgery patients, but since only 15.8% had poor function, its probably not too bad for most

Bowel function at 24 months was clearly worse for EBRT patients, but again at 17.4% reporting poor bowel function, most are free of it.

Surgery appears to be the worst overall (sexual function, incontinence), but what was surprising to me was that whatever you choose, more than a quarter of normal sexual function patients will report poor sexual function in 24 months.

For those interested:

/jamanetwork.com/journals/jama/fullarticle/2612617

Just to note, the author is a critic of retrospective studies of large cancer registries and a radiation oncologist

My two questions would be
1. Since these men were treated between 2011 and 2013, have there been advances in technology that change the numbers for the better in any of these treatment modalities?
2. With an average age of diagnosis if PC at , if I recall , 66, how much of the declines might be age related?

Just thinking out loud

Why does sexual function decline for everyone, regardless of treatment? Because we are getting older.