Men still suffering debilitating sexual and urinary dysfunction more than 12 years after prostate cancer treatment

Jang et al (2017) conducted one of the first long term follow-up on Prostate cancer (PCa) treatment 12 to 18 years after treatment. The study reveals lasting debilitating  sides effects for prostatectomy and radiation treatments.

The short side effects (2 years) for PCa treatment is well documented. However the long term quality  of men’s lives and the lasting side effects from treatments has not been reviewed until now. This is vital information for men with low to intermediate risk localised prostate cancer and are considering treatment over active monitoring or “watchful waiting”.

Highlights from Study

At 12 to 18 years after treatment, patients’ median ages were 75, 82, and 77 for RP (Radical Prostatectomy), EBRT (radiation beam therapy), and BT (Brachytherapy), respectively.

  • Patients urinary  and sexual function declined over time for all men in this study
  • Patients who underwent RP had significantly worse symptoms rating in the urinary incontinence  and sexual function over a decade later.
  • Patients that underwent EBRT had significantly worse current scores compared to baseline in the urinary incontinence and  urinary irritation/obstruction , bowel function and sexual function.
  • Patients who had BT had significantly worse current scores compared to baseline in the urinary incontinence  urinary irritation/obstruction and sexual function.
  • When comparing treatment modalities, change scores in the urinary incontinence domain were significantly worse for RP than for BT  and change scores in the urinary irritation/obstruction domain were significantly worse for EBRT or BT than for RP.

There were no significant differences between treatment groups in the bowel function domain, and all treatment groups experienced similarly large differences in sexual function scores.

 

Abstract 

Abstract Definitive treatment for prostate cancer includes radical prostatectomy (RP), external beam radiation therapy (EBRT), and brachytherapy (BT). The different side effect profiles of these options are crucial factors for patients and clinicians when deciding between treatments. This study reports long-term health-related quality of life (HRQOL) for patients in their second decade after treatment for prostate cancer. We used a validated survey to assess urinary, bowel, and sexual function and HRQOL in a prospective cohort of patients diagnosed with localized prostate cancer 14–18 years previously. We report and compare the outcomes of patients who were initially treated with RP, EBRT, or BT. Of 230 eligible patients, the response rate was 92% (n = 211) and median follow-up was 14.6 years. Compared to baseline, RP patients had significantly worse urinary incontinence and sexual function, EBRT patients had worse scores in all domains, and BT patients had worse urinary incontinence, urinary irritation/obstruction, and sexual function. When comparing treatment groups, RP patients underwent larger declines in urinary continence than did BT patients, and EBRT and BT patients experienced larger changes in urinary irritation/obstruction. Baseline functional status was significantly associated with long-term function for urinary obstruction and bowel function domains. This is one of the few prospective reports on quality of life for prostate cancer patients beyond 10 years, and adds information about the late consequences of treatment choices. These data may help patients make informed decisions regarding treatment choice based on symptoms they may experience in the decades ahead.

 

Source

Jang JW, Drumm MR, Efstathiou JA, Paly JJ, Niemierko A, Ancukiewicz M, Talcott
JA, Clark JA, Zietman AL. Long-term quality of life after definitive treatment
for prostate cancer: patient-reported outcomes in the second posttreatment
decade. Cancer Med. 2017 Jul;6(7):1827-1836. doi: 10.1002/cam4.1103. Epub 2017
May 31. PubMed PMID: 28560840; PubMed Central PMCID: PMC5504320.

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