Higher rates of long-term complications after prostate cancer treatment

Abstract

Men with prostate cancer treated with prostatectomy and radiotherapy have significantly higher rates of long-term complications after accounting for age-related symptoms and disease, according to a cohort study published in JAMA Oncology.¹

Compared to people who did not undergo prostate cancer treatment, patients who underwent prostatectomy and those who underwent radiotherapy had 7.23- and 2.76-times greater risks, respectively, of developing urinary or sexual complications at 12 years.

Radiotherapy also was linked to a 3-fold increased risk of bladder cancer and a 100-fold increased risk of radiation cystitis and radiation proctitis.

The results are based on a novel approach to assessing the long-term risk of complications following prostate cancer treatment by comparing the risk in patients with prostate cancer who underwent treatment to the risk in a control population (untreated group) that included people without prostate cancer or with untreated prostate cancer. Data for all participants were obtained from two large prostate cancer prevention trials that allowed for a comparison of rates of age-dependent functional changes that increase with age (e.g., erectile dysfunction).

Among the 29,196 participants in the two trials, 3946 had prostate cancer: 655 underwent prostatectomy, and 1056 underwent radiotherapy.

Other findings included a higher rate of artificial urinary sphincter placement 12 years after prostatectomy (4.76 cases per 1000 years of follow-up) in comparison with untreated patients (who underwent no sphincter operations) and an increased rate of penile prosthesis implantation in participants who underwent prostatectomy or radiotherapy (4.40 and 1.50 times for each 1000 years of follow-up, respectively) in comparison with untreated participants (0.43 times for each 1000 years of follow-up).

According to the study authors led by Joseph M. Unger, PhD, a biostatistician at the SWOG Statistics and Data Management Center of the Fred Hutchinson Cancer Center, the findings “should be explicitly reflected in national cancer screening and treatment guidelines and be integral to shared decision-making with patients before initiation of prostate-specific antigen screening, biopsy, or prostate cancer treatment.” They note that quantitative information such as these findings on treatment-related risks of prostate cancer are not currently included in the guidelines of any national organization, and they recommend their inclusion to help to foster informed decision-making.

Walter M. Stadler, MD, Chief Clinical Officer for City of Hope, Chicago, says that the study re-emphasizes the need to discuss long-term urinary, sexual, and bowel toxicities with patients with prostate cancer before embarking on definitive local therapy.

“More importantly, these toxicities need to be balanced with known benefits of definitive local therapy, especially in patients for whom the benefits may be minimal or even nonexistent,” he says.