Prostate Cancer Survivors Differ in Side Effects by
Treatment, But It Evens Out After 15 Years: All See Sexual, Urinary
All aggressive therapies for prostate cancer have
significant side effects and perhaps these data make an argument for
active surveillance (avoiding aggressive treatment and closely following
the cancer) in certain cases
Jan. 30, 2013 - Prostate cancer patients treated by
surgical removal of the prostate rather than radiotherapy had more
problems with urinary and sexual functions in the years after treatment,
according to a new study, but less with bowel function. The researchers
found, however, it evened out in about 15 years, although both had
significant declines in sexual and urinary function over the duration of
The study, led by first author Matthew Resnick,
M.D., instructor in Urologic Surgery, Vanderbilt University Medical
Center, was published in the Jan. 31 issue of the New England Journal
From Oct. 1, 1994, through Oct. 31, 1995,
investigators enrolled men who had been diagnosed with localized
prostate cancer in the Prostate Cancer Outcomes Study (PCOS).
For the current study, investigators followed 1,655
men between the ages of 55 and 74 from the PCOS group, of whom 1,164
(70.3 percent) had undergone prostatectomy, while 491 (29.7 percent) had
At the time of enrollment, the patients were asked
to complete a survey about clinical and demographic issues and
health-related quality of life. The men were contacted again at set
times following treatment and were asked about clinical outcomes and
disease-specific quality of life issues.
Men whose prostates had been surgically removed
were significantly more likely than those who received radiation therapy
to report urinary leakage at two years and five years. However, at 15
years, the investigators found no significant difference in the adjusted
odds of urinary incontinence. Nonetheless, patients in the surgery group
were more likely to wear incontinence pads throughout the 15-year
Men in the prostatectomy group were also
significantly more likely than those in the radiotherapy group to report
having problems with erectile dysfunction two years and five years after
"At the two- and five-year time points, men who
underwent prostatectomy were more likely to suffer from urinary
incontinence and erectile dysfunction than men who received radiation
therapy," explained Resnick. "While treatment-related differences were
significant in the early years following treatment, those differences
became far less pronounced over time."
Despite early and intermediate-term data revealing
treatment-dependent differences in patterns of sexual dysfunction, after
five years both groups had a gradual decline in sexual function.
At 15 years, erectile dysfunction was nearly
universal with 87 percent in the prostatectomy group and 93.9 percent in
the radiotherapy group reporting sexual difficulties.
The authors noted that age may have played a role
in the patients' waning sexual function, as shown in unrelated studies.
Some patients also experienced problems with bowel
function in the years following treatment. Those who were treated with
radiotherapy had more problems in the short term. Men in the
radiotherapy group reported significantly higher rates of bowel urgency
than those in the prostatectomy group at two years and five years.
However, at 15 years, despite absolute differences
in the prevalence of bowel urgency between the two groups, the
researchers found no significant difference in the odds of bowel
urgency. Men who had been treated with radiotherapy were significantly
more likely to report being bothered by bowel symptoms at both the
two-year and 15-year points.
"This study of 15-year outcomes represents a mature
portrait of quality of life issues following prostate cancer treatment,"
said David Penson, M.D., MPH, Ingram Professor of Cancer Research,
professor of Urologic Surgery and Medicine, and director of the
Vanderbilt Center for Surgical Quality and Outcomes Research, the senior
"Regardless of the form of initial treatment,
patients in this study had significant declines in sexual and urinary
function over the duration of the study. The causes of these declines
probably include advancing age and additional cancer therapies, in
addition to the original therapy," Penson said.
"Patients need to be aware that all aggressive
therapies for prostate cancer have significant side effects and perhaps
these data make an argument for active surveillance (avoiding aggressive
treatment and closely following the cancer) in certain cases."
Since the median life expectancy after treatment
for prostate cancer is 13.8 years, the authors suggested that these data
may be used by physicians to counsel men who are considering treatment
for localized disease.
Other authors for this study include Tatsuki
Koyama, Ph.D., Kang-Hsien Fan, M.S., R. Lawrence Van Horn, Ph.D.,
Vanderbilt; Peter Albertsen, M.D., University of Connecticut,
Farmington; Michael Goodman, M.D., MPH, Emory University, Atlanta; Ann
Hamilton, Ph.D., University of Southern California, Los Angeles; Richard
Hoffman, M.D., MPH, University of New Mexico and New Mexico VA
Healthcare System, Albuquerque; Arnold Potosky, Ph.D., Georgetown
University Medical Center, Washington, D.C.; Janet Stanford, Ph.D., Fred
Hutchinson Cancer Research Center, Seattle; and Antoinette Stroup,
Ph.D., University of Utah, Salt Lake City.
Funding for the research was supported by a grant
from the National Cancer Institute – a division of the National
Institutes of Health (R01-CA114524), and contracts from each of the
participating institutions (N01-PC-67007, N01-PC-67009, N01-PC-67010,
N01-PC-67006, N01-PC-67005, and N01-PC-67000). Resnick was supported by
the Veterans Affairs National Quality Scholars Program (with use of
facilities at Veterans Health Administration Tennessee Valley Healthcare
System) and the T.J. Martell Foundation.
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