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• Posted January 24, 2024

Decade-Long Study Offers Guidance on Treatments for Prostate Cancer

A new study may provide help to men newly diagnosed with prostate cancer who are faced with a daunting array of treatment options.

The study tracked 10-year outcomes and treatment side effects for nearly 2,500 men first diagnosed with prostate cancer in 2011 and 2012.

“Unlike previous studies, it focuses on contemporary treatment options,” explained study lead author Dr. Bashir Al Hussein Al Awamlh, a fellow in urologic oncology at Vanderbilt University Medical Center in Nashville, Tenn.

The study group was also diverse: About 1,800 of the patients were white, 350 were Black and 184 were Hispanic.

Patients were divided into two groups, based on how serious their disease was and their prognosis. Treatment offered to prostate cancer patients often differs based on prognosis.

Men with a "favorable" prognosis were offered four treatment options:

• Active surveillance. That's when men get no treatment, but their tumor is closely monitored in case it needs treating later on

• Nerve-sparing prostatectomy. This involves delicate surgical removal of the prostate while leaving nerves involved in erectile function intact

• External beam radiation therapy (EBRT) -- using daily radiation to kill off cancer cells

• Low-dose-rate brachytherapy. Another approach using radiation, but this time it's delivered via implanted 'seeds'

Men with an "unfavorable" prognosis got more aggressive treatments:

• Prostatectomy -- full surgical removal of the prostate

• EBRT plus androgen-deprivation therapy (ADT). ADT lowers a man's levels of circulating hormones, which can boost the effectiveness of radiation.

Among men with a "favorable" prognosis, those who opted for radical (full) prostate removal did have worse sexual function three to five years after the procedure versus those who went for other treatments, the Vanderbilt team found.

Urinary issues were also more common among this group: A quarter of all men who underwent prostate removal experienced "leakage" up to 10 years after the procedure, compared to just 4% to 11% of those who opted for EBRT. That was true for men in both the favorable and unfavorable groups.

For men in the unfavorable group, doctors saw no differences in sexual function whether they received prostatectomy or underwent EBRT/ADT.

Among men in the unfavorable group, EBRT/ADT was linked to slightly worse outcomes for bowel and hormonal issues at 10 years.

The study was published Jan. 23 in the Journal of the American Medical Association.

All of these findings "underscore the importance of counseling men with unfavorable prognosis prostate cancer differently than favorable prognosis cancer regarding expected long-term functional outcomes," senior study author Dr. Daniel Barocas said in a Vanderbilt news release.

The findings also suggest "that adverse effects of treatments on sexual function may be de-emphasized in decision-making for some men,” said Barocas, executive vice chair of urology at Vanderbilt.

He added that, for many men with a favorable prognosis for their cancer, "active surveillance" may still be the best route to go, "avoiding adverse effects associated with other treatment options."

More information

Find out more about treatments for prostate cancer at the American Cancer Society.

SOURCE: Vanderbilt University Medical Center, news release, Jan. 23, 2024