Long-term follow-up identifies treatment side effects for prostate cancer patients

A 10-year follow-up study of nearly 2,500 U.S. men who received treatment for prostate cancer will help inform decision-making around treatments and side effects for a diverse population.

The Comparative Effectiveness Analysis of Surgery and Radiation for Localized Prostate Cancer (CEASAR) study, coordinated by Vanderbilt University Medical Center (VUMC), is a multi-site research study conducting long-term follow-up in men diagnosed with cancer localized prostate between 2011 and 2012.

Researchers have now followed the same cohort of men for more than a decade, administering a series of questionnaires regarding treatment side effects related to urine, bowel, sexuality and hormone therapy. The new one released JAMA The study builds on previous publications of results over three and five years.

“Many men with localized prostate cancer survive for 15 years or more, with minimal differences in survival between different treatment strategies,” said first author Bashir Al Hussein Al Awamlh, MD, an oncology researcher. urology at VUMC. “Given this long-term horizon and similar survival rates, treatment choice for patients may be influenced by adverse effects of treatments.”

The study includes nearly 2,500 patients: 1,797 non-Hispanic white men, 350 non-Hispanic black men, 184 Hispanic men, 77 Asian men and 33 “other” races.

“Unlike previous studies, it focuses on contemporary treatment options,” added Al Hussein Al Awamlh. “It uses real-world data representative of the U.S. population, with diversity in disease severity, geographic diversity, and racial/ethnic diversity.”

Patients were classified based on cancer risk into two categories: favorable prognosis and unfavorable prognosis, which is important because patients with unfavorable prognosis receive more intensive treatments.

The favorable prognosis group chose either:

• Active surveillance, an observational strategy in which treatment is only used if the cancer gets worse over time.
• Nerve-sparing prostatectomy, surgical removal of the prostate with an attempt to protect the nerves that run along the prostate in hopes of minimizing the impact of surgery on erectile function.
• External beam radiation therapy (EBRT), a common therapy that uses daily doses of radiation to destroy cancer cells.
• Low dose rate brachytherapy, a type of radiotherapy involving the implantation of radioactive “seeds”.

The group of diseases with an unfavorable prognosis chose either:

• Prostatectomy, which is a surgical procedure to remove the prostate.
• External beam radiotherapy with androgen deprivation therapy (ADT), which is radiotherapy combined with anti-hormonal therapy used to reduce androgen hormone levels to improve the effectiveness of radiotherapy.

Results

1. Radical prostatectomy surgery was associated with an increased 10-year risk of urinary incontinence compared with other treatments, regardless of cancer risk: 14% to 25% of men who had surgery to remove the prostate reported bothersome leaks 10 years after treatment, compared with 4 to 11% of men who underwent EBRT.
2. Patients with a favorable cancer prognosis experienced more severe sexual impairment during the first three to five years after radical prostatectomy surgery compared with other treatment options. Sexual function scores were similar between treatments after five years, which may reflect age-related decline, progressive decline associated with radiotherapy, and conversion from active surveillance to treatment.
3. There were no significant differences in sexual function impairment between surgery with radical prostatectomy and radiotherapy with ADT for patients with poor prognosis cancer.
4. Radiotherapy combined with hormonal therapy (ADT) was associated with slightly worse bowel and hormonal functions at 10 years in patients with poor prognosis prostate cancer.

“The results highlight the importance of counseling men with unfavorable prognosis prostate cancer differently from those with favorable prognosis cancer regarding expected long-term functional outcomes and suggest that adverse effects of treatments on sexual function may be underestimated in decision-making for some men,” said the lead author. Daniel Barocas, MD, MPH, professor and executive vice chair of urology at VUMC.

“They also highlight the benefits of active surveillance, when oncologically safe for patients with prostate cancer with a favorable prognosis, avoiding adverse effects associated with other treatment options” , did he declare.

The authors are developing a personalized, patient-oriented prediction tool using study data to provide 10-year functional estimates based on different treatment strategies to aid decision-making.