“Active surveillance and radical prostatectomy conferred similar mental health outcomes in patients with low-risk prostate cancer; however, the surgical procedure was linked to worse urinary and sexual outcomes, according to study results.
“ ‘It is important to consider health-related quality-of-life outcomes when deciding on an approach to minimize both the physical and psychological burden of the disease and its treatment,’ Jennifer Cullen, PhD, MPH, of the Center for Prostate Disease Research at the Department of Defense, and colleagues wrote. ‘To help patients weigh the costs and benefits of [prostate cancer] management strategies, studies that examine the impact of treatment choice on short-term and long-term [health-related quality of life] are warranted. Patients who are managed with [active surveillance] may be spared some of the decline in physical [health-related quality of life] compared with patients who receive definitive treatments, such as radical prostatectomy, but they could concomitantly suffer greater mental health declines because of the anxiety of delaying therapy.’ “
“Cullen and colleagues evaluated data from 389 patients with low-risk prostate cancer enrolled in the Center for Prostate Disease Research Multicenter National Database. Of the patients, 58.6% (n = 228) of patients underwent radical prostatectomy, whereas 19.8% (n = 77) received active surveillance. The remaining 84 patients selected other treatment options and were excluded.”
The gist: A recent scientific study showed that radiation therapy that avoids damaging tissue next to a prostate tumor can be effective and preserve long-term sexual function.
“A comparison of five-year sexual function outcomes, as reported by patients treated with external beam radiotherapy (EBRT) versus combination EBRT plus brachytherapy, indicates that the utilization of vessel-sparing radiation therapy makes cure possible without compromising long-term sexual function, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 56th Annual Meeting.
“The study examined the patient-reported outcomes of 91 men with prostate cancer who received MRI-guided, vessel-sparing radiation at University of Michigan Providence Cancer Institute. The vessel-sparing radiation technique limits the amount of radiation to critical erectile tissues using MRI scans to identify the blood vessels responsible for erections. When radiation dose is limited to these critical structures, the risk of erectile dysfunction is lowered.
“Of the 91 patients studied, all patients received EBRT. Forty-two of the patients received only EBRT (>77.8Gy), and 49 patients received EBRT plus brachytherapy, the implantation of radioactive seeds near the prostate. The combination patients received brachytherapy in the form of an I-125 permanent prostate implant. None of the patients received androgen deprivation therapy (ADT)…
“ ‘In the past, men with prostate cancer expected to pay a high toll in loss of quality of life to achieve cure and were willing to accept that as necessary,’ said lead study author Patrick W. McLaughlin, MD, director of radiation oncology at University of Michigan Providence Cancer Institute in Novi, Mich. ‘This study makes it clear that even with combination radiation protocols, which are capable of curing the majority of prostate cancers more than 90 percent of the time, avoidance of critical adjacent tissues, such as vessel-sparing, makes cure and quality of life an achievable goal for many men.’ ”
A large clinical study conducted at the Veterans Affairs healthcare system found that as men age, fewer undergo prostate cancer screening and prostate biopsies, but more than 75% of those who are diagnosed with prostate cancer receive aggressive treatment. This is despite factors such as low-risk cancer type, age, and other medical conditions that may decrease life span. Experts feel that we need to improve our ability to determine who should be treated and who should not be treated for prostate cancer, but it will be difficult until a test more accurate than the prostate specific antigen (PSA) blood test is discovered.
Results of a clinical trial that evaluated the prostate cancer vaccine Provenge have come under scrutiny. Questions arise regarding the reported 4-month survival benefit that ultimately led to FDA approval. Disputers suggest that a flaw in methods led to the survival benefit, but that the vaccine may actually cause harm.
A recent study evaluated the usefulness of surgery versus observation to treat localized prostate cancer. In the study, 731 men were followed for 10 years. Those treated with surgery did not have a significant decreased risk of death compared to those who were observed for advancing cancer.
A recent study weighed the benefits of yearly prostate cancer screening, finding that the potential disadvantages decrease the potential advantages by 23%. Harmful results of yearly prostate screening include negative prostate biopsies, radical prostatectomy, and radiation therapy.
A recent study found a relationship between the SPARCL1 gene and prostate cancer recurrence. Individuals who had lower activity of the gene had a higher risk of prostate cancer recurrence over 10 years. A test to detect SPARCL1 is being designed.
The FDA has approved enzalutamide (sold as Xtandi) 3 months ahead of deadline. The drug improved survival by nearly 5 months in men with advanced prostate cancer. It is approved for individuals who have not responded to chemotherapy. However, manufacturers hope to expand approval to include patients not previously treated with chemotherapy.
The New England Journal of Medicine | Oct 25, 2012
The utility of (prostate-specific antigen) PSA screening to inform prostate cancer diagnosis and treatment has been a topic of heated debate. The New England Journal of Medicine (NEJM) conducted a poll that indicates a lack of consensus among clinicians regarding best prostate cancer screening practices. Many clinicians feel patients should make informed decisions regarding testing preferences.