Comparative Harms of Prostate Cancer Treatment Estimated in New Analysis

By Megan Brooks

January 16, 2020

NEW YORK (Reuters Health) - A new analysis provides estimates of bowel, bladder, and sexual function through five years following contemporary treatments for localized prostate cancer, which may help men clarify expectations and make more informed treatment choices, the research team says.

"It was important to perform this study because men consider the expected impact of treatment on urinary, sexual, bowel, and hormonal function when selecting among the multiple treatments for localized prostate cancer," first author Dr. Karen Hoffman from University of Texas MD Anderson Center in Houston told Reuters Health by email.

The researchers studied 1,386 men with favorable-risk prostate cancer and 619 men with unfavorable-risk prostate cancer diagnosed in 2011 through 2012, with follow up through September 2017.

In the favorable-risk group, 363 men were managed with active surveillance, 675 had nerve-sparing prostatectomy, 261 external beam radiation therapy (EBRT), and 87 low-dose-rate brachytherapy. Treatment in the unfavorable-risk group were prostatectomy (402 men) and EBRT with androgen deprivation therapy (ADT, 217 men).

In an article in JAMA, the researchers report that most urinary, bowel, sexual, and hormonal functional differences associated with the different management options attenuated over time with no "clinically meaningful" differences by five years, with the exception of prostatectomy.

Men with favorable- and unfavorable-risk disease who had prostatectomy had "clinically meaningful" worse urinary incontinence through five years compared with all other management options. And for men with unfavorable-risk disease, prostatectomy was also associated with clinically meaningful worse sexual function at five years compared to EBRT with ADT.

"Because the treatment options evaluated in this study were associated with similar prostate cancer survival and global health-related quality of life through the first five years, the differences in urinary, bowel, sexual, and hormonal function are the most salient outcomes during this period and may drive patient treatment selection," the researchers write.

"Other factors, including patient preference, perception of long-term oncologic effectiveness, time commitment for treatment and recovery, out-of-pocket expenses, salvage treatment options, and provider biases and recommendation, also affect treatment choice," they note.

"We hope doctors will use this information to counsel men on the anticipated side effects of contemporary prostate cancer treatment options, and to help men make an informed treatment choice," Dr. Hoffman told Reuters Health.

The study was supported by the Agency for Healthcare Research and Quality, the Patient-Centered Outcomes Research Institute and the National Cancer Institute.

SOURCE: JAMA, online January 14, 2020.