Recently reported data from the Prostate Cancer Outcome Study (PCOS) can “serve as a tool for a medical oncologist, a urologic oncologist, or a radiation oncologist to say, ‘Here is what could happen on average at 2, 5, 15 years after treatment with either surgery or radiation,’” according to the study’s senior author David F. Penson, MD, MPH, Director of the Center for Surgical Quality and Outcomes Research, Professor of Urologic Surgery, and Ingram Professor of Cancer Research at Vanderbilt University Medical Center in Nashville.
What did happen in the study was that 2 and 5 years after treatment, men treated with radical prostatectomy were more likely to report erectile dysfunction and urinary incontinence, and men treated with external-beam radiation reported significantly higher rates of bowel urgency. By year 15, however, “erectile dysfunction was almost universal” (occurring in 87% of those in the prostatectomy group and 93.9% of those in the radiotherapy group) and there were no significant relative differences in urinary or bowel functional outcomes.
“We know that anywhere from 20% to 50% of prostate cancers diagnosed in the PSA era are ‘overdiagnosed.’” Dr. Penson told The ASCO Post. The combination of factors—odds of overdiagnosis and the risks of erectile dysfunction, urinary incontinence, and bowel urgency—results in “many, but not all, patients being open to the idea of active surveillance,” Dr. Penson said.
Counseling patients about treatment options “requires time and a thoughtful approach,” Dr. Penson continued. “It often requires explaining the situation to the patient’s partner and to their family members.” It can be difficult to “unprogram” patients who believe that a diagnosis of cancer demands treatment, he noted. While patients may not be comfortable with the idea of active surveillance at first, “when you talk to them, often they begin to see the real benefits of closely watching their tumor and understanding that it may be in their best interest not to immediately have surgery or radiation treatment.”
Dr. Penson said “the majority of patients that I see have gone to the Internet and have talked to their friends. They want to have a role. Sure, they want the doctor’s opinion, and the doctor’s opinion is probably the most important factor in their decision-making process.” But patients “want to make their own choices about their health care,” he added, “and for health issues that have received extensive media coverage, such as prostate cancer, patients are aware that there are different treatment methods.” ■