Lymphedema and self-reported swelling among Danish survivors of prostate cancer - prevalence, clinical associations and functional implications.

PURPOSE: To study lymphedema prevalence, risk factors, and the effect on physical and emotional functioning among survivors of prostate cancer.

METHODS

Using the Danish SEQUEL cohort, we identified 44,101 survivors diagnosed with prostate cancer (2010-2021). Lymphedema was assessed using hospital-based treatment records of lymphedema from the National Patient Registry and for a sub-cohort of 9619 men as self-reported swelling in the leg(s) and other areas using EORTC items. Physical and emotional functioning were assessed using the EORTC QLQ-C30. Cox models and logistic regression analyses examined the associations between clinical, lifestyle factors and lymphedema treatment/swelling, and the relationship between swelling and physical/emotional functioning.

RESULTS

Among survivors, 2% received lymphedema treatment and 8% reported swelling. The risk of receiving lymphedema treatment was higher for survivors with metastatic vs. low-risk disease (hazard ratio (HR) 5.38, 95% confidence interval (CI) 4.50-6.44), radical prostatectomy vs. active surveillance (HR 4.80, 95% CI 3.37-6.82), and radiation or endocrine therapy vs. watchful waiting (HR 3.44, 95% CI 1.92-6.15; HR 9.01, 95% CI 5.43-14.96, respectively). Survivors with obesity vs. healthy weight had a higher risk of self-reported swelling (odds ratio (OR) 3.52, 95% CI 2.87-4.34). Swelling was associated with impaired physical (OR 3.75, 95% CI 3.20-4.41) and emotional function (OR 4.41, 95% CI 3.44-5.62).

CONCLUSION

Radical prostatectomy, radiation, endocrine therapy, metastatic disease, and obesity increase the risk of lymphedema treatment. Self-reported swelling was associated with impaired physical and emotional functioning, underscoring the need for targeted monitoring and lifestyle interventions.