Differences in Prostate Cancer Treatment Outcomes Diminish Over Time

NASHVILLE, TN – Outcomes between treating prostate cancer with surgery compared to radiation no longer were significant after 15 years of initial treatment, according to a new study.

A recent report of a study comparing outcomes among prostate cancer patients treated with surgery vs. radiotherapy found differences in urinary, bowel and sexual function after short-term follow-up, but those differences were no longer significant 15 years after initial treatment.1

The study, led by first author Matthew Resnick, MD, a urologic surgery specialist at the Nashville VAMC and Vanderbilt University said that, in the short term, however, the treatment options differed in effect on urinary, bowel and sexual function. The report, which used participants from the Prostate Cancer Outcomes Study (PCOS), was published earlier this year in the New England Journal of Medicine.

For the research, initially conducted from Oct. 1, 1994, through Oct. 31, 1995, 1,655 men with localized prostate cancer and ranging in age from 55 to 74 were followed. Of those, 1,164, 70.3%, had undergone prostatectomy, while 491, 29.7%, had undergone radiotherapy. The patients, who were asked to complete a survey about clinical and demographic issues and health-related quality of life at the initiation of the study, were contacted again at set times following treatment and queried about clinical outcomes and disease-specific quality of life issues.

Urinary leakage at two years and five years were more likely to be reported by men whose prostates had been surgically removed as opposed to those who had just received radiation therapy. At 15 years, however, the investigators found no significant difference in the adjusted odds of urinary incontinence, although patients in the surgery group reported that they were more likely to wear incontinence pads throughout the 15-year follow-up period.

Patients who had undergone prostatectomy also were significantly more likely than the radiotherapy group to report problems with erectile dysfunction two years and five years after surgery. After five years, both groups had a gradual decline in sexual function and, by 15 years, the vast majority of both men in both groups reported erectile dysfunction — 87% in the prostatectomy group and 93.9% in the radiotherapy group.

“At the two- and five-year timepoints, men who underwent prostatectomy were more likely to suffer from urinary incontinence and erectile dysfunction than men who received radiation therapy,” explained Resnick. “While treatment-related differences were significant in the early years following treatment, those differences became far less pronounced over time.”

Citing unrelated studies, the authors blamed age rather than prostate cancer treatment for the declining sexual function.

Radiotherapy therapy resulted in significantly higher rates of bowel urgency than in those in the prostatectomy group at two years and five years. While absolute differences in the prevalence of bowel urgency between the two groups were noted at the 15-year mark, the researchers found no significant difference in the odds of bowel urgency, although men who had been treated with radiotherapy were significantly more likely to report being bothered by bowel symptoms at both the two-year and 15-year points in time.

“Regardless of the form of initial treatment, patients in this study had significant declines in sexual and urinary function over the duration of the study. The causes of these declines probably include advancing age and additional cancer therapies, in addition to the original therapy,” said David Penson, MD, MPH, also at both the VA and Vanderbilt. “Patients need to be aware that all aggressive therapies for prostate cancer have significant side effects and perhaps these data make an argument for active surveillance [avoiding aggressive treatment and closely following the cancer] in certain cases.”

  1. Resnick MJ, Koyama T, Fan KH, Albertsen PC, Goodman M, Hamilton AS, Hoffman RM, Potosky AL, Stanford JL, Stroup AM, Van Horn RL, Penson DF. Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013 Jan 31;368(5):436-45. doi: 10.1056/NEJMoa1209978. PubMed PMID: 23363497.

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