Adverse effects from definitive treatment of localized prostate cancer (PCa), such as urinary incontinence and sexual dysfunction, persist for more than a decade and differ according to the type of treatment, according to a new study.
In Cancer Medicine, Anthony L. Zietman, MD, of Massachusetts General Hospital in Boston, and colleagues reported survey results from 194 patients who underwent radical prostatectomy (RP); external beam radiation therapy (EBRT); or brachytherapy during 1994 to 2000. (Nine percent of EBRT patients also had a brachytherapy boost.) Patients reported bothersome symptoms on the Prostate Cancer Symptom Indices, the Expanded Prostate Index Composite, and the Physical Component Summary and Mental Component Summary of the 12-Item Short Form Health Survey.
Over a median follow-up of 14.6 years, all patients reported worse functioning in some areas after treatment than before. RP patients had significantly worse urinary incontinence and sexual function. EBRT patients scored worse in every domain, including urinary incontinence, irritation, and obstruction, bowel function, and sexual function. Brachytherapy patients reported worse urinary incontinence, urinary irritation or obstruction, and sexual function.
Comparing treatment modalities, RP patients showed greater decline in urinary continence than brachytherapy patients, according to the investigators. EBRT and brachytherapy patients had more urinary irritation or obstruction than surgery patients. No significant differences in bowel function were found among the groups. All patients reported considerable decline in sexual function, regardless of treatment modality.
Patients’ functionality prior to definitive therapy significantly correlated with urinary obstruction and bowel function more than 10 years later, but not with urinary incontinence or sexual function. Age was the only significant predictor of current sexual function. The investigators suggested that all men may develop severe sexual dysfunction over time regardless of treatment modality. At 12 to 18 years after treatment, patients’ median ages were 75, 82, and 77 years for RP, EBRT, and brachytherapy, respectively. The researchers could not assess the possible influences of androgen deprivation or salvage therapy.
“This is one of the few prospective reports on quality of life for prostate cancer patients beyond 10 years, and adds information about the late consequences of treatment choices,” Dr Zietman and colleagues commented. “These data may help patients make informed decisions regarding treatment choice based on symptoms they may experience in the decades ahead.”
The researchers acknowledged that evolution in techniques and technology may have affected results. In addition, the study did not randomly assign patients to treatment or have a control group of untreated patients, which are limitations.
Jang JW, Drumm MR, Efstathiou JA, et al. Long-term quality of life after definitive treatment for prostate cancer: patient-reported outcomes in the second posttreatment decade. Cancer Med. 2017 May 31. doi: 10.1002/cam4.1103. [Epub ahead of print]