For men with low-risk prostate cancer, the side effects of treatment may not be worth the benefit.
The word “cancer” is scary. Faced with a diagnosis of prostate cancer, men may think the best approach would be an aggressive one.
However, research suggests that men whose prostate cancer is considered low risk should seriously consider “active surveillance” – careful monitoring – instead of treatment. Surgery or radiation therapy can have side effects that hinder a man’s quality of life, like erectile dysfunction and urinary incontinence.
A study led by Dr. Daniel Barocas, a urologic surgeon with Vanderbilt Urology, compared side effects and outcomes (results) among men who had cancer that had not spread beyond the prostate. Some of these patients received treatments such as surgery or radiation, while others were followed only with observation, “active surveillance.”
“Patients who were treated with surgery or radiation had side effects,” Barocas said. “Those managed with active surveillance, for the most part, did quite well. What we found is that it is best to avoid treatment if you have a prostate cancer that is safe to observe. This is why most doctors recommend ‘active surveillance’ for low-risk cancers.”
Regardless of approach, 99 percent of the men were alive after three years. Prostate cancer tends to grow slowly, so patients will need to be followed 10 years or longer to detect any difference in death rate.
Men treated with surgery were more likely to have erectile dysfunction and urinary incontinence than those treated with radiation. The difference in sexual dysfunction was only apparent in patients with excellent function before surgery.
There were these additional findings from the study:
- 14 percent of men reported urinary incontinence as a moderate or big problem three years after surgery, compared with 5 percent who had radiation.
- Men who had radiation reported more problems with bowel function compared with men who had surgery, but these differences were only seen within the first year following treatment.
- Surgery was associated with fewer “urinary irritative symptoms,” like weak urine stream or urinary frequency, compared with active surveillance.
- Radiation patients had similar urinary irritative symptoms to men on active surveillance, which is an improvement from previous studies with older radiation techniques.
- None of the treatments had an impact on general quality of life, such as the ability to do activities of daily living, emotional health and energy or vitality.
Because of these findings, any man with a low-risk prostate cancer should “seriously consider active surveillance as a reasonable way to go,” said Dr. David Penson, a Vanderbilt urologic surgeon and co-author of the study.
Teamwork that leads to personalized care
The Vanderbilt Urology Clinic offers the newest and most thorough care for a wide range of urologic problems, including cancer, incontinence, kidney stones and sexual health problems, including erectile dysfunction (impotence). For an appointment, call 615-322-2880.
