PRO findings may guide localized prostate cancer treatment decision-making
medwireNews: Two sets of findings could help men choosing between radical prostatectomy (RP), external beam radiotherapy (EBRT), brachytherapy, and active surveillance for localized prostate cancer.
The authors of an opinion accompanying the cohort studies in JAMA explain that both research teams “anticipated that perhaps their findings would differ from those in the ProtecT trial, because these studies included participants who had received more modern treatment options that were expected to have improved adverse effect profiles.”
“However, the findings from both studies were remarkably consistent with the ProtecT trial in terms of overall rates of symptoms and adverse effects, confirming that all options carry risks of adverse effects that affect quality of life,” observe editorialists Freddie Hamdy, from the University of Oxford in the UK, and Jenny Donovan, from the University of Bristol in the UK.
The authors of the first study used the Expanded Prostate Cancer Index Composite to determine whether current treatment modalities show clinically important differences in sexual function, urinary incontinence, urinary irritative symptoms, bowel function, and hormone function over 3 years.
Their cohort included 2550 men aged 80 years or less who were diagnosed with clinical stage T1–2 disease between 2011 and 2012 and underwent RP (59.7%), EBRT (23.5%), or active surveillance (16.8%).
After 3 years, the RP group had a greater decrease in their mean sexual function domain score than patients who received EBRT, whereas the EBRT and active surveillance groups did not have a clinically significance difference in this outcome.
Patients who underwent RP also had worse urinary incontinence at 3 years than the other treatment groups, but RP did offer a better outcome in terms of urinary irritative symptoms than active surveillance, report Daniel Barocas (Vanderbilt University Medical Center, Nashville, Tennessee, USA) and co-workers.
And by 12 months, the three treatment groups did not differ with regard to bowel or hormone function, health-related quality of life (QoL) or disease-specific survival, they add.
“These findings may facilitate counseling regarding the comparative harms of contemporary treatments for prostate cancer,” the team summarizes.
The authors of a second article reporting QoL of 1141 men treated with contemporary options following a new diagnosis of localized prostate cancer in 2011–2013 agree.
“In this cohort of men with localized prostate cancer, each treatment strategy was associated with distinct patterns of adverse effects over 2 years,” write Ronald Chen (University of North Carolina, Chapel Hill, USA) and colleagues.
“These findings can be used to promote treatment decisions that incorporate individual preferences.”
The cohort was followed up using the Prostate Cancer Symptom Indices before and 3, 12, and 24 months after active surveillance (27.5%), RP (41.1%), EBRT (21.8%), or brachytherapy (9.6%).
By 2 years, most of the mean scores in the four domains of sexual dysfunction, urinary incontinence, urinary irritation and obstruction, and bowel problems did not differ between the treatment groups.
But the researchers note that at 3 months, patients who underwent surgery or received either of the radiation options had worsened mean sexual dysfunction scores compared with the active surveillance group.
At the same checkpoint, RP patients experienced greater worsening of urinary incontinence, and EBRT and brachytherapy patients had more acute worsening of urinary obstruction and irritation, compared with their active surveillance counterparts. EBRT was also associated with greater deterioration of bowel symptoms than active surveillance at 3 months.
Chen et al admit that QoL findings may not be static over the ongoing follow-up but observe that “as the ProtecT trial showed, there may be little change in QOL after 2 years.”
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