Adverse Effects, Quality of Life of Treatment vs. no Treatment for Men with Localized Prostate Cancer
26 Mar 2017
Two studies published by JAMA examine the adverse effects and quality of life as reported by men with localized prostate cancer who chose treatment, observation or active surveillance.
In one study, Daniel A. Barocas, M.D., M.P.H., of Vanderbilt University Medical Center, Nashville, and colleagues included 2,550 men (average age, 64 years) with localized prostate cancer who received treatment with radical prostatectomy (n=1,523; 60 percent), external beam radiation therapy (EBRT; n=598; 24 percent), or chose active surveillance (n=429; 17 percent). Patient-reported outcomes were collected via survey at enrollment and 6, 12, and 36 months after enrollment.
The researchers found that radical prostatectomy was associated with a greater decrease in sexual function and urinary incontinence than either EBRT or active surveillance after three years and was associated with fewer urinary irritative symptoms than active surveillance; however, no meaningful differences existed in either bowel or hormonal function beyond 12 months or in other domains of health-related quality-of-life measures.
“This information may facilitate patient counseling regarding the expected harms of contemporary treatments and their possible effect on quality of life,” the authors write.
In another study, Ronald C. Chen, M.D., M.P.H., of the University of North Carolina at Chapel Hill, and colleagues included 1,141 men with newly diagnosed prostate cancer to compare quality of life (QOL) after radical prostatectomy (n=469; 41 percent), external beam radiotherapy (n= 249; 22 percent), and brachytherapy (n=109; 9.6 percent) vs active surveillance (n=314; 28 percent). Median age was 66 to 67 years across groups. Quality of life was assessed by surveys at baseline (pretreatment) and 3, 12, and 24 months after the treatment date, with scores given on measures of function of various domains.
The researchers found that compared with active surveillance, average sexual dysfunction scores worsened by three months for patients who received radical prostatectomy, external beam radiotherapy, and brachytherapy. Compared with active surveillance at three months, worsened urinary incontinence was associated with radical prostatectomy; acute worsening of urinary obstruction and irritation with external beam radiotherapy and brachytherapy; and worsened bowel symptoms with external beam radiotherapy. By 24 months, average scores between treatment groups vs active surveillance were not significantly different in most domains.
“These findings can be used to promote treatment decisions that incorporate individual preferences,” the authors write.