A study led by Ronald C. Chen, MD, examines quality–of–life outcomes for modern treatment choices most patients will face, including active surveillance, radical prostatectomy, external beam radiation treatment, and brachytherapy.
For many men newly diagnosed with early–stage prostate cancer, concerns about potential quality–of–life issues often guide treatment decisions. A new study led by UNC Lineberger Comprehensive Cancer Center researchers identifies distinct patterns of side effects that patients could use to guide their choices.

Published in the Journal of the American Medical Association, the study examines quality–of–life outcomes for the treatment choices most patients will face. Those choices include active surveillance, radical prostatectomy, external beam radiation treatment, and brachytherapy, a treatment that involves inserting radioactive seeds into the prostate.

“Patients diagnosed with early–stage prostate cancer face many treatment options that are thought to be similarly efficacious,” said Ronald C. Chen, MD, MPH, associate professor in the UNC School of Medicine Department of Radiation Oncology. “Therefore, the quality–of–life differences among these options become an important consideration when patients are trying to make their decisions.”

“There has not been a large–scale comparison of the quality–of–life impact for these modern options, until now,” Chen said. “Existing quality of life studies have studied older types of surgery and radiation that are no longer used, and patients need updated information regarding the impact of modern treatment options so they can make informed decisions about the choices they face today.”

For the study, UNC Lineberger researchers surveyed 1,141 men who were diagnosed with early–stage prostate cancer between January 2011 and June 2013. They compared patients’ self–reported quality of life related to bowel, urination, and sexual function across four strategies: active surveillance; prostatectomy; external beam radiotherapy; and brachytherapy. Almost all prostatectomy patients received robotic surgery, and almost all external beam radiotherapy patients received intensity–modulated radiation, reflecting modern treatment technologies.

Prostatectomy was linked to higher sexual dysfunction and urinary leakage than the other options. At two years after treatment, more than 57 percent of men who had normal sexual function prior to treatment reported poor sexual function after surgery, compared with 27 percent who reported poor sexual function after external beam radiation, 34 percent after brachytherapy, and 25 percent after active surveillance.

“With modern robotic surgery, sexual dysfunction and urinary incontinence continue to be some of the side effects that surgery can cause,” Chen said. “While we do see improvement over time, even at the two–year point, surgery still causes more of these issues than other treatments.”

Meanwhile, other treatment choices were linked to worse scores for other side effects. External beam radiotherapy and brachytherapy caused more short–term urinary tract obstruction and irritation, while external beam radiotherapy was linked to more short–term bowel symptoms.

For the group of men who chose active surveillance, urinary issues and sexual function worsened over time. This is likely partly due to aging, and partly due to some men who experienced cancer progression that necessitated treatments that caused these side effects.

“At the two–year time point, patients who chose radiotherapy or brachytherapy actually had quality–of–life results similar to patient who chose active surveillance, and that may be surprising to some patients,” Chen said.