For men with ‘low-risk’ prostate cancer, the side effects of treatment may not be worth the benefit.
The word “cancer” is scary. Faced with a diagnosis of prostate cancer, men may think the best approach would be an aggressive one.
Men whose prostate cancer is considered low risk should seriously consider “active surveillance,” a new study suggests. Surgery or radiation therapy can present side effects that hinder a man’s quality of life, like erectile dysfunction and urinary incontinence.
The study compared side effects and outcomes of current prostate cancer treatments with careful observation, or “active surveillance.” Men in the study had cancer that had not spread beyond the prostate.
The findings may help a man and his doctor identify the best course of action for him.
What the study found
“Patients who were treated with surgery or radiation had side effects,” said Daniel Barocas, M.D., MPH, a urologic surgeon at Vanderbilt. “Those managed with active surveillance, for the most part, did quite well.
“It is best to avoid treatment if you have a prostate cancer that is safe to observe. This is why most doctors recommend ‘active surveillance’ for low-risk cancers.”
Regardless of approach, 99 percent of the men were alive after three years. Prostate cancer tends to grow slowly, so patients will need to be followed 10 years or longer to detect any difference in death rate.
Men treated with surgery were more likely to have erectile dysfunction and urinary incontinence than those treated with radiation. The difference in sexual dysfunction was only apparent in patients with excellent function before surgery.
Other specific findings:
- 14 percent of men reported urinary incontinence as a moderate or big problem three years after surgery, compared to 5 percent who had radiation.
- Men who had radiation reported more problems with bowel function compared to men who had surgery, but these differences were only seen within the first year following treatment.
- Surgery was associated with fewer “urinary irritative symptoms,” like weak urine stream or urinary frequency, compared to active surveillance.
- Radiation patients had similar urinary irritative symptoms to men on active surveillance, which is an improvement from previous studies with older radiation techniques.
- None of the treatments had an impact on general quality of life, such as the ability to do activities of daily living, emotional health and energy or vitality.
Because of these findings, any man with a low-risk prostate cancer should “seriously consider active surveillance as a reasonable way to go,” said David Penson, M.D., MPH, also a Vanderbilt urologic surgeon and co-author of the study.
Editor’s note: Funding for the study was provided by grants 1R01HS019356 and 1R01HS022640 from the Agency for Healthcare Research and Quality; UL1TR000011 to the Vanderbilt Institute of Clinical and Translational Research from the National Center for Advancing Translational Sciences; and 5T32CA106183 from the National Institute of Health and the National Cancer Institute (Dr. Tyson). Research reported in this article was partially funded through a Patient-Centered Outcomes Research Institute (PCORI) award CE12-11-4667.
This story was adapted from an article that initially appeared in the VUMC Reporter.
Vanderbilt Urology Clinic offers the latest, most comprehensive care for a wide range of urologic diseases and conditions, including cancers of the prostate, bladder and kidneys and other urologic cancers; incontinence and other bladder-control problems; kidney stones; and sexual health problems, including erectile dysfunction (impotence). Details: 615-322-2880.
Daniel A. Barocas, M.D., M.P.H., F.A.C.S., is an associate professor of Urology at Vanderbilt University Medical Center. His research focuses on urologic oncology. In 2017, he received the Society of Urologic Oncology’s Young Investigator Award.
David Penson, M.D., M.P.H., is the Paul V. Hamilton, M.D., and Virginia E. Howd Chair of Urologic Oncology, Professor and Chair of the Department of Urology and Professor of Medicine and Health Policy at Vanderbilt University Medical Center. His research is focused on the comparative effectiveness of treatments for localized prostate cancer.