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Long-term treatment-related quality of life outcomes in men with localized prostate cancer

Key clinical point: Patients undergoing active treatment for localized prostate cancer had worse long-term self-reported quality of life. Men who underwent radical prostatectomy faired especially badly, particularly in relation to long-term sexual outcomes.

Major finding: At 15 years, persisting problems with erectile dysfunction were common in all treatment groups (range, 62.3% [active surveillance/watchful waiting, n=33/53] to 83.0% [non-nerve sparing radical prostatectomy, n=117/141] for treatment groups; 42.7% [n=44/103] in controls). Men who had external beam radiation therapy/high-dose rate brachytherapy or androgen deprivation therapy as a primary treatment reported more bowel problems. Urinary incontinence was particularly prevalent and persistent for men who underwent radical prostatectomy.

Study details: This Australian population-based, prospective analysis with over 15 years of follow-up included 1,642 men with localized prostate cancer (aged less than 70 years) and 786 control individuals.

Disclosures: The study was partially funded by grants from the Australian Commonwealth Department of Veterans Affairs, the National Health and Medical Research Council of Australia, and

the Cancer Institute New South Wales. The authors reported financial support from Cancer Institute New South Wales.

Commentary

“Surgery, radiation, and/or androgen deprivation provide patients with localized prostate cancer significant benefits, yet many patients who undergo these treatments experience side effects. As these patients may live many years, long term studies (i.e. ten years or more in follow-up) are necessary but challenging. Mazariego et al. describe the results of a fifteen-year quality of life prospective cohort study of patients with localized prostate cancer and a matched cohort of men without prostate cancer. Key findings included 1) all treatment groups had higher levels of erectile dysfunction compared with control, with the highest incidence in patients undergoing non-nerve sparing prostatectomy, 2) bowel issues were most common in men who underwent radiation, and 3) urinary issues were most common in men treated with androgen deprivation. The findings further support the need for in-depth counseling on the risks and benefits of particular treatments for localized prostate cancer.”

Mark Klein, MD

Citation:

Mazariego CG et al. BMJ. 2020 Oct 7. doi: 10.1136/bmj.m3503.