Insights into adverse effects may help guide prostate cancer treatment decision-making
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Adverse events experienced by men with prostate cancer varied considerably based on the treatment they received, results of a 10-year follow-up study showed.
The multicenter Comparative Effectiveness Analysis of Surgery and Radiation for Localized Prostate Cancer (CEASAR) study collected longitudinal data from about 2,500 men diagnosed with localized prostate cancer in 2011 or 2012.
Those characterized as having favorable prognosis chose between active surveillance, nerve-sparing prostatectomy, external beam radiation therapy (EBRT) or low-dose-rate brachytherapy.
Those determined to have unfavorable-prognosis disease group chose prostatectomy or EBRT with androgen deprivation therapy (ADT).
Researchers administered questionnaires to assess incidence of urinary, bowel, sexual or other adverse events. The findings — which build on earlier results reported at 3 years and 5 years — can help inform decision making among this population, investigators concluded.
“Many men with localized prostate cancer survive for 15 years or more, with minimal differences in survival among various treatment strategies,” study author Bashir Al Hussein Al Awamlh, MD, fellow in urologic oncology at Vanderbilt University Medical Center, told Healio. “We sought to understand how different treatments affect the functional outcomes of patients with localized prostate cancer.”
Healio spoke with Al Hussein Al Awamlh about the study’s findings, a patient-facing prediction tool his team is developing, and what oncologists can do to counsel and prepare their patients for potential treatment-related effects.
Healio: Why did you conduct this study?
Al Hussein Al Awamlh: The rationale of this study was to provide data on the long-term side effects of modern treatment strategies for prostate cancer to aid in treatment decision-making.
Healio: Can you summarize the key findings?
Al Hussein Al Awamlh: Surgery with radical prostatectomy was associated with increased risk for urinary incontinence over 10 years compared with other treatments, irrespective of cancer risk. A total of 14% to 25% of men who underwent surgery to remove the prostate reported bothersome leakage 10 years after the treatment, compared with 4% to 11% of men who underwent EBRT.
Patients with favorable cancer prognoses experienced worse sexual impairment for the first 3 to 5 years after surgery with radical prostatectomy compared with [those who underwent] other treatment options. Sexual function scores were similar across treatments after 5 years, which may reflect age-related decline, gradual decline associated with radiation and conversion from active surveillance to treatment.
We observed no significant differences in sexual function impairment between surgery with radical prostatectomy or radiation with ADT for patients with unfavorable prostate cancer.
Lastly, radiation therapy combined with hormone therapy was associated with slightly worse bowel and hormone functions at 10 years for patients with unfavorable-prognosis prostate cancer.
Healio: How can your findings guide treatment decision-making?
Al Hussein Al Awamlh: We hope our findings will help physicians counsel their patients in making informed decisions by understanding what to expect after each treatment. When patients are likely to live many years after treatment, long-term side effects are likely to play a major role in deciding which treatment to undergo. Of course, this is provided that the available options are oncologically safe.
Healio: Why is it important to counsel patients with favorable-prognosis prostate cancer differently than those with unfavorable prognoses?
Al Hussein Al Awamlh: Treatment intensity and options differ according to cancer prognosis, and side effects of treatment options over the 10-year follow-up are different for each prognosis. Therefore, counseling patients and gauging their expectations should be different according to their disease prognosis. For example, in favorable-prognosis prostate cancer, sexual function is impaired after radical prostatectomy for 3 to 5 years compared with other treatment options. However, in unfavorable-prognosis prostate cancer, there was no difference in sexual function impairment between surgery and radiation therapy with ADT.
Active surveillance includes actively monitoring prostate cancer for progression, with the intention to intervene with surgery or radiation therapy if the cancer progresses. By avoiding or delaying treatment for some patients, it allows those with low-risk cancer to live without enduring the side effects associated with treatments for many years.
Healio: Why might clinicians de-emphasize adverse effects of treatment on sexual function during decision-making?
Al Hussein Al Awamlh: We found that the degree of sexual function impairment was not different between surgery and radiation in patients with unfavorable prognosis. That should be considered when discussing side effects of treatments for patients with unfavorable prognosis prostate cancer.
Healio: Your team is using study data to develop a prediction tool to aid in decision-making. Can you tell us about it?
Al Hussein Al Awamlh: The tool uses patients’ baseline function and disease characteristics to predict their function — sexual, urinary, bowel and hormone — and chances of experiencing specific side effects after different treatment options over 10 years (eg, chances of requiring a pad for urine leakage). The goal is to help patients understand side effects based on their own function and provide information unique to each patient to gauge their expectations so they can make the decision that is best for them. We hope this tool will help physicians counsel patients when discussing long-term side effects.
References:
- Al Hussein Al Awamlh B, et al. JAMA. 2024;doi:10.1001/jama.2023.26491.
- Long-term follow up pinpoints side effects of treatments for prostate cancer patients (press release). Available at: https://www.newswise.com/articles/long-term-follow-up-pinpoints-side-effects-of-treatments-for-prostate-cancer-patients?sc=dwhr&xy=10019952. Posted Jan. 22, 2024. Accessed Feb. 14, 2024.
For more information:
Bashir Al Hussein Al Awamlh, MD, can be reached at Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37732; email: bashir.alhussein@vumc.org.
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