Functional Outcomes and Adverse Effects of Prostate Cancer Treatments – Diane Newman

For the past 30 years, I have treated men referred because of the adverse effects of prostate cancer (PCa) treatments. These patient complaints include lower urinary tract symptoms of incontinence, urgency, frequency, and sexual complaints such as erectile dysfunction and loss of libido. I have heard comments from these men such as “I wish I never had the surgery” and “I never thought I would not be able to swing a golf club without wetting myself” and “I can’t get an erection anymore- I didn’t expect that”.  Thus, I was not surprised by the findings of a population-based, prospective cohort study by Wallis and colleagues (2021). 


These researchers used Surveillance, Epidemiology, and End Results (SEER)–based registries in the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) cohort to assess the association between treatment approach, functional outcomes, patient expectations, and treatment-related regret among patients with localized PCa. This is an analysis of 2072 men (median age, 64 [IQR, 59-69] years).  Sadly, 279 men (13%) reported treatment-related regret at 5 years after diagnosis, 11% (183) who had undergone surgery (radical prostatectomy), 11% (76) who had undergone radiotherapy (external beam radiotherapy, brachytherapy, or both), and 7% (20) who had undergone active surveillance. That was more than 1 in 10 men reporting treatment-related regret!  Sexual dysfunction, but not other patient-reported functional outcomes (e.g. bladder or bowel dysfunction, etc), was significantly associated with regret. This data points to the disconnect between patient expectations and outcomes, both as it relates to treatment efficacy and adverse effects. Expectations and outcomes appeared to drive treatment-related regret to a greater extent than other factors such as urinary incontinence and other lower urinary tract symptoms, erectile dysfunction, or bowel dysfunction. Take away for clinicians - improved counseling at the time of diagnosis and before treatment is needed.

Written by: Diane Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practitioner (NP), Co-Director, Penn Center for Continence and Pelvic Health Director, Clinical Trials, Division of Urology, Adjunct Professor of Urology in Surgery, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

References:

Wallis CJD, Zhao Z, Huang LC, Penson DF, Koyama T, Kaplan SH, Greenfield S, Luckenbaugh AN, Klaassen Z, Conwill R, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O'Neil BB, Hoffman KE, Barocas DA. Association of Treatment Modality, Functional Outcomes, and Baseline Characteristics With Treatment-Related Regret Among Men With Localized Prostate Cancer. JAMA Oncol. 2021 Nov 18:e215160. doi: 10.1001/jamaoncol.2021.5160

Related Content:
Treatment-Related Regret Among Men With Localized Prostate Cancer Journal Club - Christopher Wallis & Zachary Klaassen

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