In 2007, retired engineer Ralph Conwill was diagnosed with prostate cancer. The news came as a shock. “I told my urologist that I just wanted the cancer out,” Conwill says. “But he explained that I had treatment choices involving different outcomes to consider.”

Now a PCORI-funded study at Vanderbilt University, for which Conwill was a patient partner, can help men make a more informed decision about prostate cancer treatments by providing evidence about the effects of those treatments. Among men with prostate cancer at relatively low risk of spreading to other parts of the body, surgery caused more long-term sexual dysfunction and urinary incontinence than radiation, while men who elected radiation experienced slightly more bowel symptoms. Fewer men on active surveillance reported these side effects after three years, the team reported in JAMA.

As one of the approximately 3 million American men with prostate cancer, Conwill had to decide what treatment to seek. His cancer was confined to the prostate, but because it was at intermediate risk of spreading, he was advised to seek immediate treatment. That meant he could choose between surgery and radiation. Both treatments have proven effective in keeping nearly all men with similar cancers alive for at least five years. After a two-hour-long consultation with a radiation oncologist, Conwill remained convinced that surgery was best for him.

Many men with localized prostate cancer like Conwill’s face the same choice, and those with low-risk cancer can also consider no immediate treatment. Instead, they receive active surveillance, which includes repeated testing. Though research has shown that the three options give men the same high likelihood of surviving for 10 years, little information has been available about how the treatment options affect men’s quality of life.

“Our study’s take-home message is patients who can safely do active surveillance should consider that very carefully,” says the study’s principal investigator, David Penson, MD, MPH.

The study looked at the health records of 2,550 men diagnosed in 2011 or 2012 with localized prostate cancer who lived in one of five places: Utah, New Jersey, Louisiana, Atlanta and rural Georgia, and the Los Angeles area.

The men chose among contemporary treatments being offered around the country, such as laparoscopic (also called minimally invasive) surgery and advanced radiation therapy. “The study reflects real-world practice,” Penson says. “That allowed us to generate information that is relevant and germane to men who are diagnosed in 2017.”

Over half of the men in the study had disease at intermediate or high risk of spreading to other parts of the body. They needed to choose either surgery or radiation. The remaining 45 percent, with cancer at low risk of spreading, also considered active surveillance. The study followed all of the men for three years.

Men who had had surgery to remove their prostates were more likely to report sexual dysfunction and urinary incontinence than men who had radiation or underwent active surveillance. Radiation caused slightly more bowel dysfunction than surgery and was more likely than active surveillance to decrease sexual function.

Posted: June 16, 2017