A new article just published by Taylor et al. in the Journal of Clinical Oncology provides detailed information about the persistence of clinically significant, long-term, prostate cancer-specific, treatment-related sexual and urinary adverse effects up to 10 years post-diagnosis. Coverage of this article also appears in a report on Reuters.com.
Taylor and her colleagues used data from prostate cancer patients who participated in the the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening study to assess long-term disease-specific functioning of the survivors compared to men with no cancer (controls) and other factors.
They collected data from prostate cancer survivors (n = 529), 5 to 10 years post-diagnosis and matched these data to similar data from the control patients (n = 514) based on race, screening center, year of enrollment, and trial arm. All participants were asked to complete a telephone interview regarding prostate cancer-specific symptomatology.
The basic results of the study were actually based on data from 269 men who’d had prostate cancer detected and treated after screening and 260 men who’d also been screened but remained cancer-free. They showed that:
- At up to 10 years post-treatment, prostate cancer survivors had poorer sexual and urinary function compared with controls (P< 0.001).
- More than 95 percent of survivors had some degree of sexual dysfunction.
- About 50 percent of survivors had urinary symptoms.
- There was no significant relationship between trial arm and clinical outcome (P > 0.31).
- Patients treated with radiation therapy of some type (n = 110) reported poorer bowel function (P < 0.05) but better sexual (P < 0.05) and urinary (P < 0.001) function than radical prostatectomy patients (n = 201).
- Patients who received androgen deprivation therapy (ADT) as part of a treatment combination (n = 207) reported poorer hormone-related symptoms than men treated with radical prostatectomy alone (P < 0.05).
According to Taylor and her colleagues:
- This is the first study to clearly show “the persistence of clinically significant, long-term [prostate cancer-specific] treatment-related sexual and urinary adverse effects up to 10 years postdiagnosis.”
- This is the first study to directly compare prostate-related dysfunction among screened survivors versus screened, non-cancer controls.
- This is the first study to clearly show that these long-term problems are attributable to prostate cancer treatment and not just to aging or co-morbidities.
The authors are also careful to note that “differences in long-term adverse effects between treatment modalities are particularly relevant for patients and clinicians when making treatment decisions.”
However, we do need to be very clear that some of the participants in the PLCO trial were treated as long ago as 1994, and that treatment has improved a great deal in the intervening 15 or so years. It would certainly be inappropriate to conclude that patients treated today would necessarily have the same risk for side effects and complications as similar patients treated 10 to 15 years ago.