Men who underwent surgery or radiation therapy for treatment of prostate cancer experienced no significant differences in patient-reported outcomes at 15 years post-diagnosis, according to a newly published study in the New England Journal of Medicine
The study, which assessed health status in more than 1,600 men with prostate cancer, showed similar rates of incontinence and sexual dysfunction at the 15-year mark, despite differing rates at two years and five years post-diagnosis among surgery and radiation therapy patients.
Those long-term results, the authors say, should aid physicians and patients in making decisions about which treatments, if any, to pursue.
“There are a number of men who benefit from treatment for prostate cancer, but a large number who don't,” Dr. Matthew Resnick, an instructor in Vanderbilt University Medical Center's department of urologic surgery, and the study's lead author, said in an interview. “Our goal is to tease out who is a good candidate and optimize their function in the longer term.”
Men who underwent prostatectomy, or surgical removal of the prostate gland, were five times as likely as men who underwent radiotherapy to experience urinary incontinence and twice as likely to have erectile dysfunction, at the five-year point.
Ten years later, at the 15-year mark, sexual and urinary function had decreased markedly for all patients but the differences between the two treatment groups had flattened, according to the study. Similarly, although men in the radiotherapy group experienced far more issues with bowel function than did surgery patients, there was no significant difference in adjusted odds of bowel problems between the two groups by the 15-year time point. “The causes of these declines probably include both advancing age and additional cancer treatments,” the authors wrote.
Because prostate cancer treatments have varying success rates and because choosing to do nothing—also known as “watchful waiting”—has gained ground as a viable option, the disease is a prime example of the benefits of patient engagement and shared decisionmaking, Resnick said.
“What we are beginning to learn is how men make decisions, what their value structures are and how we can align treatment options,” he said. “Our hope is that these data can be incorporated into these discussions. That's not to say no one should be treated for prostate cancer, but men really need to think about what the tradeoffs are and what their long-term quality of life may be.”