COMMENTARY

Reframing Prostate Cancer as 'Chronic Disease'

Timothy Daskivich, MD; Matthew J. Resnick, MD

Disclosures

May 22, 2013

In This Article

Long-term Quality-of-Life Outcomes in PCOS

Dr. Daskivich: You recently published a study[6] in the New England Journal of Medicine on the long-term quality-of-life outcomes in PCOS. What were the take-home messages of that study?

Dr. Resnick: We compared men who underwent external beam radiotherapy with those who underwent surgery within 1 year of diagnosis within PCOS and found some differences early on in survivorship experience. Men who underwent radical prostatectomy were more likely to have urinary incontinence or erectile dysfunction from 2 to 5 years, but the differences between the groups attenuated from 5 to 15 years. Interestingly, the declines that we saw in all of the domains that we investigated -- urinary incontinence, sexual dysfunction, and bowel dysfunction -- continued from 5 to 15 years. Although there were differences at 5 years, we saw no statistically significant differences at 5 to 15 years between patients undergoing surgery or radiation. One of the biggest take-away messages was that the absolute risk of having any of those declines was considerable. When we think about the overall survivorship experience and balancing the benefits and harms of prostate cancer treatment, these are issues that need to be reported to men upfront.

Dr. Daskivich: So, not only do men suffer with quality of life in the beginning, but it also lasts not only 5 years but out to 15 years.

Dr. Resnick: Correct.

Dr. Daskivich: This represents their total survivorship. We can tell men that for the rest of their lives, they are going to be dealing with some of these problems.

Dr. Resnick: That's true. One of the limitations of the study is that we can't tease out how much of the health-related quality-of-life outcomes are from the treatment for prostate cancer, the prostate cancer itself, or just the aging process.

Dr. Litwin at UCLA has published a number of studies[7,8] looking at the burden of urinary, sexual, and bowel dysfunction in men without prostate cancer, so we know that over time, men begin to develop some of these dysfunctions. What proportion of that is attributable to prostate cancer or its treatment remains unknown.

Dr. Daskivich: It's very interesting. Your study taught me that the problems with quality of life that we incur from aggressive treatment are not only lasting, but they actually get worse over time. They're equivalent across surgery and radiation.

Dr. Resnick: Right.

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