PCa Commentary
 

What The Media Is Saying About Us ... Actually About What Was Released Regarding The September 15 Jnci Article, “Five-Year Outcomes After Prostatectomy Or Radiotherapy For Prostate Cancer: The Prostate Cancer Outcomes Study.” (Oct. 2004)

The “MEMO TO THE MEDIA” accompanying this quality-of-life report begins with:“Five years after prostate cancer diagnosis, patients treated with radical prostatectomy continue to experience worse urinary incontinence and erectile dysfunction compared to those treated with radiotherapy. However, patients in both groups have similar overall sexual function, mostly because of declining function among radiotherapy patients between 2 and 5 years after diagnosis...”

Although there are numerous credible reports in our specialized journals about quality-of-life after treatment which may differ from the JNCI findings, those assessments do not reach the public as this report has.

The JNCI study updated its previously published 2 year findings and was based on “patient self-reports as well as reviews of inpatient and ambulatory medical records of men 55 - 74 years old (901, surgery; 286, external beam radiotherapy) treated for clinically localized prostate cancer between 1994 and 1995. The six collaborating institutions include the Division of Cancer Control, NCI, and the Fred Hutchinson. The full report indicates the researchers’ meticulous effort to consider, and adjust for, many factors that might influence the accuracy of the findings. Of particular interest were trends that were seen during the interval between the years 2 and 5. Their major focus was on post treatment urinary incontinence, and dysfunctions in bowel and sexual areas. In the five year report a separate category was added which analyzed symptoms described as “bothersome”, and each area of concern was queried in great detail, considerably more extensively than reported below. Brachytherapy was not evaluated.

In brief, the major findings:

1)   Urinary incontinence (defined as “having no control or frequently leaking urine”) at five years: 14.4% surgery, 4.9% radiotherapy. “Incontinence and overall bother” was 4 - 6 times more frequent in surgical patients (13.9 vs 3.0%). When “bother” was evaluated in terms of ”slow or difficult urination and urgency”: RP - 11.6% vs 23.9% RT. The outcomes at five years did not change significantly from the 2 year findings.

2)   Bowel urgency: RP 17,7% vs 33.4% RT; painful hemorrhoids, 11% RP vs 15.7% RT. Diarrhea: RP 23.3% vs. 28.8% RT.

3)   Sexual function: “Both groups reported substantial decrements in sexual function at 5 years after diagnosis.” The query focused on the categories: “achieving and maintaining erections; and frequency of sexual activity, and sexual interest. Whereas at 2 years impotence after RP was reported at 82.1%, at five year it was nearly unchanged at 79.3%. However, impotence worsened over time for RT; 50.3% at year 2, 65% at year 5. On the specific area of “erection insufficient for intercourse” at 5 years: 76.9% RP; 73.1% RT. No mention was made regarding results of nerve sparing surgical techniques. The analysis was adjusted for the use of androgen deprivation and erectile enhancing measures, and these issues did not affect the results. Androgen deprivation was utilized at 2 years in the RP group in 6% of men increasing to 8% at five years; in the RT group it was 3% increasing to 10%.

An accompanying editorial by Ian Thompson took note of “the growing evidence of substantial and long-lasting side effects from prostate cancer treatment”. He acknowledged that we have “good evidence of treatment outcomes but poor evidence of treatment benefit”. The potential extent of the impact of these quality-of- life issues is implied in his observation that “92% of men screened for prostate cancer have PSA levels less than 4.0 ng/mL, ... and of this group ”15% had prostate cancer [data from the Prostate Cancer Prevention Trial], and “of these, 15% had high grade disease”. He concludes “We need to develop better ways to identify those men for whom the benefits of treatment outweigh the harm.”

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