Once diagnosed with prostate cancer, men often face a difficult decision of choosing the best treatment. Should they have surgery, radiation or simply watch to see if the disease spreads?
Two new studies give doctors and patients the clearest information yet about the possible adverse effects of these options.
Researchers at Vanderbilt University studied treatment side effects in over 2,500 men diagnosed with early stage prostate cancer, or cancer in which the disease had not yet spread outside the prostate, according to the results published Tuesday in the Journal of the American Medical Association. The patients received either surgery, radiation, or were simply watched by their doctor. After three years those who had received surgery experienced greater sexual problems and urinary incontinence.
However, when looking at other problems such as bowel complications, hormonal disruptions, or other deterioration in quality of life, after a year there were no meaningful differences between the groups.
A similar study conducted by Dr. Ronald Chen at the University of North Carolina at Chapel Hill looked at over 1,100 men diagnosed with early prostate cancer from January 2011 until June 2013. Like the Vanderbilt study, surgery was shown to be associated with more sexual dysfunction and urinary incontinence.
Despite these side effects, differences in overall quality of life tended to diminish with time.
The results show that men should not focus on a specific treatment's immediate side effects, urologist Dr. Daniel Barocas, lead author of the Vanderbilt study told NBC News. Instead, patients should have a discussion with their doctors where quality-of-life issues like sexual dysfunction are weighed against a treatment’s effectiveness.
“If prostate cancer kills you, it usually does so in the future,” Barocas said. “We need to think about the long term.”
The problem is that many of the treatment options presented to patients today are relatively new, such as minimally invasive robotic surgeries. Barocas said. These surgeries involve small incisions combined with radiation which preserves the health of the tissue surrounding the prostate. Unfortunately, data does not yet exist which measures how effective these new, less damaging, options can be at curing a patient’s cancer.
A patient’s baseline risk level for developing an aggressive disease should be taken into account when making a treatment decision.
“Low-risk men will do well regardless of what you do,” said Barocas. However, individuals who may have a higher risk cancer may be pushed towards more invasive options, like surgery, to help contain their more aggressive disease.
Men with a family history of cancer, who are African-American race are at a greater risk of more aggressive disease.
Controversy over Screening
The need for individualized treatment decisions is also related to prostate cancer screening.
Prostate cancer screening practices have become controversial since the 2012 United States Preventive Services Task Force recommended against the use of regular PSA, or “Prostate Specific Antigen,” blood testing due to concerns about men who may have been unnecessarily harmed by over-treament. Despite the recommendation, many medical groups still advocate PSA testing, fearing patients with aggressive cancers will be missed.
Since that recommendation, there has been a sharp fall in prostate cancer diagnoses, from approximately 240,000 to 180,000 per year. It kills about 30,000 men a year.
A diagnosis of prostate cancer can be extremely unsettling, prompting patients to make difficult decisions over an uncertain future. With the new studies, “now patients and their doctors can make a shared decision, about what is the right decision for the individual," said Barocas.
Anthony Serritella is a medical fellow with NBC News. He is currently a medical student at the Johns Hopkins School of Medicine.