Different Men, Different Outcomes

By Cari Wade Gervin
Monday, January 25, 2021

A new study may help men make more informed decisions about prostate cancer treatment.

Five years after treatment for localized prostate cancer, most side effects have waned, but differences in urinary and erectile function remain.

That’s according to the latest results from the ongoing Comparative Effectiveness Analysis of Surgery and Radiation for Localized Prostate Cancer, or CEASAR, study analyzing long-term results in more than 3,600 men diagnosed with prostate cancer between 2010 and 2012.

The study, published in JAMA in January 2020, may help physicians and patients better decide on which treatment options to pursue after a diagnosis.

“Since treatment options and treatment intensity vary based on cancer severity, we evaluated patient-reported function after treatment for favorable-risk prostate cancer separately from function after treatment for unfavorable-risk disease,” said Karen E. Hoffman, MD, MHSc, MPH, the lead author of the study and an associate professor in the Department of Radiation Oncology at the University of Texas MD Anderson Cancer Center, in a press release.

Patients in the study filled out surveys describing their side effects before treatment started, then repeated the survey at six months, one year, three years and five years later. Participants with favorable risks were treated with active surveillance, nerve-sparing prostatectomy, external beam radiation therapy (EBRT) or low-dose rate brachytherapy, while those with unfavorable risks received prostatectomy or EBRT with androgen deprivation therapy.

It has been commonly observed that men have worse erectile function immediately after prostatectomy that improves over time, while radiation leads to a slower but noticeable decline — observations that the study confirmed, at least in the case of the favorable-risk group. However, the study showed men in the unfavorable-risk group had similarly disappointing erectile function five years out, no matter which treatment they received. And all participants experienced overall declines.

“For sexual function, all of the treatment options, even surveillance, were associated with significant declines,” said senior author Daniel Barocas, MD, MPH, associate professor and Vice Chair of Urology at Vanderbilt University Medical Center, in a press release. “While the time course is different for surgery and radiation, our study shows that only about half of men undergoing these treatments who had erections good enough for intercourse before treatment will still have an erection good enough for intercourse five years later.”

CEASAR now has funding to continue the study another five years. It also has a prediction model in beta version that may ultimately prove a helpful addition to making decisions regarding treatment plans.

The study also found that prostatectomy led to more incontinence, compared with other treatments, in both the favorable and unfavorable groups. However, improvements in bowel function over time remained consistent across treatments. Brachytherapy patients reported worse continence-related side effects during the first year, compared with patients who received external beam radiation.