Localised Prostate Cancer Treatment-Related Side Effects, QoL Characterised

Patient experiences in the first 2–3 years after localised prostate cancer treatment differ with treatment modality

medwireNews: Patient-reported outcomes (PROs) and quality of life (QoL) have been described in two cohort studies of US men with localised prostate cancer who were managed with surgery, radiotherapy or active surveillance care.

“These findings may facilitate counselling regarding the comparative harms of contemporary treatments for prostate cancer”, suggest Daniel Barocas, from Vanderbilt University Medical Center in Nashville, Tennessee, USA, and co-authors of the first of the articles, both of which are published in JAMA.

They followed-up 2550 men aged less than 80 years who were diagnosed between 2011 and 2012 with cT1–2 prostate cancer and a prostate-specific antigen (PSA) level below 50 ng/mL, 55% of whom had intermediate- or high-risk disease.

Within a year, 59.7% underwent radical prostatectomy (RP), 23.5% received external beam radiotherapy (EBRT) and 16.8% chose active surveillance. The patients were assessed before treatment and again after 3 years using the patient-reported function of the Expanded Prostate Cancer Index Composite (EPIC).

The authors explain that the EBRT group were older and had poorer sexual function before treatment than those who chose surgery.

At 3 years, the RP group had a greater decrease in their adjusted sexual domain score than patients who chose EBRT, whereas there was no difference in sexual domain score decline between the EBRT and active surveillance groups.

Surgical patients also had worse urinary incontinence than both their EBRT and active surveillance counterparts, but had better urinary irritative symptoms than patients who received active surveillance.

Nevertheless, beyond 12 months, there was no difference in bowel or hormone function measures between the three treatment groups, with health-related QoL and disease-specific survival also comparable.

The second study, by Ronald Chen, from the University of North Carolina at Chapel Hill, USA, and co-authors used the Prostate Cancer Symptom Indices to compare QoL in 1141 men with newly diagnosed localised prostate cancer between 2011 and 2013.

The assessments – performed before patients began active surveillance (27.5%), RP (41.1%), EBRT (21.8%) or brachytherapy (9.6%) and again after 3, 12 and 24 months of follow-up – showed “distinct patterns of adverse effects over 2 years”, they report.

“These findings can be used to promote treatment decisions that incorporate individual preferences”, the researchers believe.

When compared with active surveillance patients, patients who received EBRT or brachytherapy experienced a trend to worsening mean sexual dysfunction scores at 3 and 12 but not 24 months, while RP patients had clinically significant poorer scores than those who received active surveillance at 3 and 12 months.

RP was also associated with a greater increase in urinary incontinence compared with active surveillance at 3, 12 and 24 months, whereas neither of the radiation options showed a difference.

Meanwhile, brachytherapy was associated with significantly greater worsening of urinary obstruction and irritation at 3 and 12 but not 24 months compared with active surveillance, and EBRT was associated with clinically significant worsening symptoms at 3 months.

By contrast, RP patients had lower urinary obstruction and irritation than their active surveillance counterparts at 12 and 24 months.

EBRT was also associated with a clinically significant greater deterioration of bowel symptoms than active surveillance at 3 months only, while bowel symptoms did not differ between the active surveillance, brachytherapy and RP groups at any time point.

Thus, by the 24-month check-up, the average scores for the QoL measures did not significantly differ between the treatment groups for most domains.

The authors note that follow-up is ongoing but suggest that, similar to the earlier results from the ProtecT trial, which reported on PROs over 10 years after treatment for localised prostate cancer, there may be “little change” in QoL after 2 years.


Barocas DA, Alvarez J, Resnick MJ, et al. Association between radiation therapy, surgery, or observation for localized prostate cancer and patient-reported outcomes after 3 years. JAMA 2017; 317: 1126–1140, 21 March. doi:10.1001/jama.2017.1704

Chen RC, Basak R, Meyer A-M, et al. Association between choice of radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance and patient-reported quality of life among men with localized prostate cancer. JAMA 2017; 317: 1141–1150, 21 March. doi:10.1001/jama.2017.1652

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