In a nutshell
The authors aimed to determine the long-term effects of early prostate cancer treatment.
Some background
Early prostate cancer is usually treated with active surveillance, radiation therapy, androgen deprivation therapy or surgery. Active surveillance involves the monitoring of cancer progression in a patient without administering active treatment. Radiation therapy involves the application of radiation beams at the cancer site and can include external beam radiation (EBRT – external radiation source focused at the tumor site) or brachytherapy (radioactive seeds are placed internally at the tumor site.
Androgen deprivation therapy (ADT) is a hormone therapy that targets the male sex hormones involved in prostate cancer, such as testosterone. Surgery usually involves a radical prostatectomy which is the removal of the prostate gland and surrounding cancerous tissues. Nerve-sparing radical prostatectomy is a technique that aims to prevent erectile dysfunction after surgery by avoiding the nerves that control erections.
Methods & findings
The aim of this study was to determine any long-term issues following early prostate cancer treatment.
This study involved 3,294 patients who received treatment with active surveillance, radical prostatectomy, nerve-sparing radical prostatectomy, EBRT, brachytherapy or ADT. The average follow-up time was 74 months.
All treatments led to a decline in physical function with ADT showing the largest decline in physical function over 10 years. Compared to nerve-sparing radical prostatectomy, all treatments (besides active surveillance) experienced meaningful declines in physical function at 2 years. EBRT and ADT showed an increased likelihood of declining mental health at 2 years compared to nerve-sparing radical prostatectomy.
Sexual function decreased in the first year in all treatments. Nerve-sparing radical prostatectomy showed a better recovery of function compared to non-nerve-sparing radical prostatectomy, which was associated with a worse functional decline at all time frames used (2 years, 5 years and 10 years). Radical prostatectomy overall had the most pronounced impact on sexual functioning recovery.
Surgery had the most negative effect on urinary function compared to non-surgical treatments, with functioning remaining lower than normal after 2 years recovery. EBRT and brachytherapy had the most negative effect on bowel functioning.
The bottom line
The authors conclude that patients experience decreased functioning for the first 2 years after treatment, with different treatments resulting in different adverse effects.
The fine print
The main limitation of this study was attrition (patients dropping out of the study).
What’s next?
Please consult your doctor if you are considering radiation or surgery and have concerns about the after-effects of treatment.
Published By :
European Urology
Date :
Sep 18, 2014
