Individuals with localized prostate cancer have 3 treatment options which include; EBRT (radiation), radical prostatectomy (surgery) and active observation. Each modality has its positives but this study focuses on the negatives associated with each.
In a new prospective study, 2,550 men were grouped based on their treatment modality. 1,523 (59.7%) men underwent radical prostatectomy, 598 (23.5%) were under EBRT (radiation) and 429 (16.8%) were in active observation. To be eligible, patients had to be younger than 80 years, have a prostate-specific antigen (PSA) level of less than 50ng/ml, clinical stage T1 to T2 cancer, no nodal or metastases when evaluated and enrolled in this study within 6 months of diagnosis of prostate cancer. This study had a run date of 3 years with survey assessments done at enrollment and at 6,12 and 36 months after enrollment.
The EPIC-26 (Expanded Prostate Cancer Index Composite) instrument was used to track the primary outcome of disease-specific function. Scores range from 0-100 and the higher the score, the better. MCID (minimal clinically important difference) was also assessed, which tracked sexual function and hormonal activity (hot flashes, gynecomastia, low energy and weight change).
Individuals that underwent radical prostatectomy had the highest baseline sexual function compared to the other treatment modalities. However, this group of patients showed a greater drop in sexual function compared to the 2 other groups. For urinary incontinence, the baseline scores were similar in all 3 groups. However, EBRT had the greatest drop in scores after the 3-year run, followed by surgery. For bowel function, declines were not very common. Patients in the surgery group showed improved scores compared to EBBT, while EBBT scores were lower compared to active surveillance. Initially for hormone function, EBRT scores were lower than surgery and observation, but after the trial, the decrease was not statistically significant. With respect to survival rates, the 3 groups were very similar, all above 95%.
This study provides information on the most common adverse effects for patients undergoing treatment for localized prostate cancer. Physicians and health professionals can use the information from this study to make the best clinical decision. One limitation in this study was that it only lasted for 3 years. To be considered cancer free, a patient would need to be in remission for at least 5 years.
Written By: James A. Ogbeide Jr., PharmD