Prostate cancer

New Studies Compare Harms and Benefits of Localized Prostate Cancer Treatments

Two new cohort studies compared changes in quality of life and the occurrence of adverse events associated with contemporary treatments for localized prostate cancer.

Dr Ronald Chen, of the department of Oncology at the University of North Carolina in Chapel Hill, and colleagues examined incidence of adverse events associated with various treatment options in 1141 men who had prostate cancer.1 Of the 1141, 469 underwent radical prostatectomy, 249 underwent external beam radiotherapy, 109 underwent brachytherapy, and 314 underwent active surveillance. Quality of life was assessed with the Prostate Cancer Symptom Indices—which included sexual dysfunction, urinary obstruction and irritation, urinary incontinence, and bowel problems—at baseline and 3, 12, and 24 months after treatment.
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Their findings included the following:

  • Patients who underwent radical prostatectomy, external beam radiotherapy, and brachytherapy had greater incidence of sexual dysfunction at 3 months compared to patients under active surveillance.
  • Both external beam radiotherapy and brachytherapy were associated with worse urinary obstruction and irritation in patients at 3 months.
  • Patients who underwent external beam radiotherapy had worse bowel symptoms at 3 months.

“By 24 months, mean scores between treatment groups vs active surveillance were not significantly different in most domains,” the researchers wrote.

In a similar study, Dr Daniel Barocas at the Department of Urologic Surgery at Vanderbilt University Medical Center and colleagues reported adverse events associated with the treatment of prostate cancer in 2550 men, 1523 of whom underwent radical prostatectomy, 598 of whom underwent external beam radiation therapy, and 429 of whom underwent active surveillance.2 Sexual function, urinary incontinence, urinary irritative symptoms, bowel function, and hormonal function were assessed at baseline and 36 months after treatment using the 26-item Expanded Prostate Cancer Index Composite.

According to their findings:

  • Radical prostatectomy was associated with significant declines in sexual function and urinary incontinence compared with external beam radiation therapy and active surveillance.
  • Beyond 12 months, no meaningful differences for bowel or hormone function between active surveillance, external beam radiation therapy, and radical prostatectomy were observed.

Both research teams recommended that physicians and patients use their findings to compare the harms and benefits for each treatment option, and individualize prostate cancer treatment with patients’ preferences.

—Melissa Weiss

Reference:

1] Chen RC, Basak R, Meyer AM, et al. Association between choice of radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance and patient-reported quality of life among men with localized prostate cancer [published online March 21, 2017]. JAMA. doi:10.1001/jama.2017.1652.

2] Barocas DA, Alvarez J, Resnick MJ, et al. Association between radiation therapy, surgery, or observation for localized prostate cancer and patient-reported outcomes after 3 years [published online March 21, 2017]. JAMA. doi:10.1001/jama.2017.1704.