Adverse Reactions to Treatments of Localized Prostate Cancer: A 5-Year Study
Posted: Wednesday, February 12, 2020
Adverse effects from prostate cancer treatments can include sexual, urinary, or bowel dysfunction. Karen Hoffman, MD, MHsc, MPH, of The University of Texas MD Anderson Cancer Center, and colleagues performed a 5-year follow-up study called CEASAR of more than 2,000 men who received treatment for prostate cancer in the United States. Their findings were published in JAMA.
“We are providing information about the side effects of different treatments for prostate cancer that men and their providers can use to make treatment decisions,” said senior study author Daniel Barocas, MD, MPH, of Vanderbilt University Medical Center, Nashville, in an institutional press release.
The study participants constituted 1,386 men with favorable-risk and 619 men with unfavorable-risk prostate cancer. Treatments for favorable-risk prostate cancer were comprised of active surveillance, external-beam radiation therapy, low-dose–rate brachytherapy, or nerve-sparing prostatectomy. Unfavorable-risk prostate cancer treatments were extensive radiation treatment therapy, full prostatectomy, or external-beam radiation therapy with added androgen-deprivation therapy. The researchers surveyed patients at 6 months, 12 months, 3 years, and 5 years after treatment using the Expanded Prostate Index Composite to evaluate bowel, sexual, hormonal, and urinary function, as well as bladder irritation.
No statistically significant differences were found in hormone function across any of the groups over the entire course of the study, whereas there was an overall decline in erectile function. There was an increase in both bowel dysfunction and urinary irritation after low-dose–rate brachytherapy at 6 and 12 months compared with the other treatments groups; however, at 5 years, there was no difference among them. Patients who received external-beam radiation therapy showed a decrease in bowel function at 6 and 12 months, but rebounded at 5 years. Prostatectomy resulted in impaired urinary function compared with other treatments.
“There is more to a treatment decision than just the side effects,” commented Dr. Barocas. “The most obvious being the effectiveness of the treatment, and that is something we hope to be able to demonstrate as we are now funded to look at 10-year cancer outcomes.”
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.