Prostate Cancer: Surgery and Radiation Have Similar Long-term Toxicities

Photo of linear accelerator
Linear accelerator for radiation therapy                         (Photo credit: Wikipedia)

A recent student represents the first large-scale comparison of long-term quality of life among patients treated with radical prostatectomy versus external beam radiation therapy (EBRT) for prostate cancer. Today, we turn to this important research.

Study: Dr. Matthew Resnick and colleagues used data from the Prostate Cancer Outcomes Study, a population-based cohort of patients whose prostate cancer had been treated in the mid 1990s and who had been prospectively followed for 15 years. The goal? To compare urinary, bowel, and sexual function after prostatectomy or radiation therapy for localized prostate cancer. Included were 1,655 men between the ages of 55 and 74. Of these 1,164 had surgery and 491 had radiation therapy. Researchers examined functional status at baseline and again at 2, 5, and 15 years after diagnosis. Full results may be found in the New England Journal of Medicine 2013;368:436-334.


Pro-radiation: Patients who had surgery were more likely to not be able to control their urine (urinary incontinence) compared to radiation therapy (at 2 years: over 6x more likely; at 5 years, over 5x more likely. By 15 years, however, there were no differences between radiation therapy and surgery in terms of urinary incontinence. Surgery also led to more impotence at 2 years (3.5x more likely) and 5 years (2x more likely), but the treatment groups were similar by 15 years. By 15 years, the impotence chance was around 80% if you started out with good function, and nearly 90% if you did not!

Pro-surgery: Patients undergoing prostatectomy were less likely to have bowel urgency at 2 years (radiation therapy 2.5x more likely to cause it) and 5 years (double the risk with radiation therapy). The % that dropped bowel function was about 10% for radiation, and 5% for surgery by 15 years.

My take: Give that the median survival following treatment for prostate cancer approaches 14 years, it is important to look at long-term quality of life among men living with a diagnosis of prostate cancer. This study hints at potential compromises in quality of life with either radiation therapy or surgery. However, it is not a randomized trial, and the study loses power over time as the number of men followed shrinks (for example, due to death from other causes). At 15 years, there were no significant relative differences in disease-specific functional outcomes comparing surgery versus radiation therapy. Still, caveat emptor: Men treated for localized prostate cancer commonly had declines in all functional domains during 15 years of follow-up. If you are contemplating treatment for low-risk prostate cancer, ask carefully about side effects. And ask if you might be a candidate for active surveillance. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Coming Soon for iPad:  Understand Colon Cancer in 60 Minutes; Understand Diet & Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes, and Understand Breast Cancer in 60 Minutes. All can be found at the Apple Ibooks store. Thank you.

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Harvard AB Yale MD UPenn Radiation Oncology Radiation Oncologist, Seattle area

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