THE "NEW" PROSTATE CANCER INFOLINK

A new paper by Meissner et al. has reported important, long-term data on fear of recurrence and biochemical progression of prostate cancer among a large cohort of German patients undergoing radical prostatectomy. This appears to be the largest such study to date.

The results of this study are based on a total of 2,417 survivors from the multicenter German Familial Prostate Cancer Database all of whom had been initially treated by radical prostatectomy.  These patients completed the Fear of Progression Questionnaire – Short Form twice: on average at 7 years after radical prostatectomy (T1 in 2010) and again at follow-up 9 years later (T2 in 2019). i.e., 16 years after their initial surgery.

It should be noted that > 10,000 patients were initially invited to participate in this study. Patients could have been diagnosed and treated for their prostate cancer from as early as 1993. More than 7,500  dropped out or were ineligible for one of a variety of reasons:

• 237 did not, in fact, have a radical prostatectomy as their primary treatment.
• 234 had died prior to distribution of the first survey in 2010.
• 3,566 did not appropriately complete that first survey in 2010.
• 2,029 more patients were lost to follow-up or were known to have died by the time of distribution of the second survey in 2019.
• 124 of those eligible for the second survey were found to have died after distribution of the second survey in 2019.
• 1,502 of those eligible did not appropriately complete the second survey in 2019.

The fundamental results of this study are as follows:

• Average (mean) age of patients at time of the the initial survey was 69.5 ± 5.9 years.
• 6.5 percent of patients reported clinically evident fear of cancer recurrence (FCR) at the initial assessment (T1).
• 8.4 percent of patients reported clinically evident FCR at the second, follow-up assessment (T2).
• Predictors of FCR at T2, i..e, 9 years later than the initial assessment (T1), included
  • A lower level of education (odds ratio [OR] = 4.35)
  • Time since radical prostatectomy (OR = 1.10)
  • Biochemical recurrence of cancer (OR = 1.67)
  • No current adjuvant therapy (OR = 2.38)
  • FCR at the time of the first survey  (OR = 10.75)
  • Anxiety at the time of the first survey (OR = 1.35)

Meissner et al. conclude that:

FCR remains a burden to certain [prostate cancer] survivors even many years after their diagnosis and treatment. Health care professionals should monitor for FCR and identify patients at risk to provide appropriate psychosocial care because FCR is leading to limitations in quality of life and psychological well-being.

Having said this, there is one crucial set of information that was not reported in this study.

The authors appear to have made no attempt to assess the risk levels of these patients at the time of their original diagnosis and treatment. One has to wonder whether this may have affected the FCR and anxiety levels of these patients over time. Many of these patients, treated as far back as 1993, may have been given surgical treatment for low-risk forms of disease. This could have led to bias in that it could have been the higher-risk patients who had higher levels of FCR and anxiety over time — but we have no way to know that based on the data provided.

On the other hand, this study does seem to indicate that the vast majority of the patients who completed this study (> 90 percent) had relatively low levels of clinically evident FCR at 7 and 16 years after their initial diagnosis and treatment.

The full text of this paper is available on line for interested readers, as is the full text of an editorial commentary by Bergerot et al.

Filed under: Living with Prostate Cancer, Management | Tagged: fear, outcome, recurrence, surgery, survey |