Men who have been newly diagnosed with prostate cancer say they would trade some improvement in their odds of survival for improvements in side effects and quality of life, according to research presented by Ahmed et al at the 2018 National Cancer Research Institute (NCRI) Cancer Conference (Abstract 1967).
Treatment for prostate cancer can include surgery or radiotherapy, both of which sometimes cause urinary incontinence and a loss of sexual function. Some patients will spend weeks or months recovering from treatments and some may need a second round of treatment. Findings from the COMPARE study suggest that, while patients value a longer life, they also value quality of life—and may be willing to choose less treatment on that basis.
The study was presented by Hashim Ahmed, PhD, FRCS(Urol), Chair and Professor of Urology, Imperial College London, and Chair of NCRI’s Prostate Cancer Clinical Studies Group. He explained, “Men with early prostate cancer have to choose between active surveillance, with regular checkups, and more invasive therapy, such as removal of the prostate gland or radiotherapy. Previous research suggests that men with low-risk prostate cancer do not gain improvements in survival at 10 years following treatment. Men with high-risk prostate cancer gain a 5% improvement in 10-year survival with treatment. In men with medium-risk disease, there is uncertainty over whether treatment affects survival.”
“Men who have treatment do suffer side effects including urinary incontinence, requiring daily use of pads; loss of erectile function, despite medication like [sildenafil citrate]; and some will require further treatment. We know men wish to live longer, but many men get depressed following treatment, and their quality of life and personal relationships are affected.”
Dr. Ahmed and his colleagues worked with 634 men who had been newly diagnosed with prostate cancer at UK hospitals. The men had only been told their diagnosis and given general information. They had not yet discussed any specific treatment with their clinicians. In all cases, the cancer had not yet metastasized. Seventy-four percent had low- or medium-risk disease, and 26% had high-risk disease. The mean age was 67.7 years old.
Men were presented with two different hypothetical treatments that were different in terms of their likely impact on survival, incontinence, impotence, recovery time, and the chance of needing further treatment. The men were asked to say which of the two hypothetical treatments they would pick, and this was repeated several times with varying impacts on survival and side effects.
Based on the men’s choices, researchers were able to quantify how important each factor was for the men, on average.
Survival was the most important factor to the men surveyed, followed by avoiding incontinence, not needing further treatment, and maintaining an erection. However, findings also suggested that patients were willing to make trade-offs between side effects and survival.
The choices the men made suggest that, on average, they were willing to give up a 0.68% chance of improved survival if that meant they could gain a 1% improvement in the chance of keeping urinary function. They were also willing to give up a 0.41% chance of improved survival in return for a 1% improvement in the chance of not needing more treatment. For a 1% chance of being able to achieve erections, they were willing to trade a 0.28% chance of improved survival.
Dr. Ahmed said in a statement, “It’s easy to assume that patients’ key motivation is survival, but this research shows the situation is more nuanced. Men do want long life, but they highly value treatments that have low side effects, so much so that, on average, they were willing to accept lower survival if it meant the risk of side effects was low. The amount of lower survival they were willing to accept is about the same as the small benefit they might expect from radical surgery or radiotherapy instead of active surveillance. Each patient differs as to what treatment they prefer, but it may help them to know that many men think about the balance between the quantity and the quality of life, and they should not feel it is wrong to have similar thoughts.”
Dr. Ahmed said that more research is needed in less invasive treatments such as focal therapy, as well as in how active surveillance can be improved by using imaging instead of repeat biopsies.
Disclosure: See study authors’ full disclosures at conference.ncri.org.uk.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.