Prostate cancer is commonly diagnosed, but does not always require treatment, which can have detriments on quality of life. Researchers found that across surgery, radiotherapy and monitoring, there was no significant difference in mortality, though surgery and radiotherapy reduced the likelihood of disease progression and metastases.
As our ability to diagnose and treat prostate cancer has grown, society’s awareness and willingness to undergo screening has increased. An unintended side effect of this is treatment of prostate tumours that would not progress to have meaningful symptoms anyways. Prostate cancer progresses slowly and many men die of other causes before it takes effect. Meanwhile, men may undergo unnecessary treatment that can have adverse effects on their quality of life.
Upon prostate cancer diagnosis, one of three methods is often chosen: monitoring, radiotherapy, and surgery. Monitoring involves regular checkups and blood tests for indicators of cancer progression. Radiotherapy can be undertaken via a number of methods, but all revolve around exposing the cancer cells to high energy radiation to induce cell death and disease remission. In surgery, the malignant mass is removed, often along with other tissue to ensure complete removal. In radiotherapy and surgery, complications and side effects such as urinary issues, bowel problems, erectile dysfunction and loss of fertility can occur.
In a new study published in the New England Journal of Medicine, the research group of Hamdy et al. investigated the effectiveness of monitoring, surgery, and radiotherapy in the treatment of clinically localized prostate cancer. Prostate cancer-specific mortality, all-cause mortality, incidence of metastases and disease progression were all outcomes of the study with a 10-year follow-up. 1643 men were randomized into the three different treatment options with reviews if patient status changed.
In clinically localized prostate cancer, only approximately 1% of patients experienced prostate cancer-specific mortality at 10 years follow-up regardless of treatment and only 10% of patients experienced all-cause mortality. Disease progression and incidence of metastases were decreased in surgery and radiotherapy compared to monitoring, but these did not translate to changes in mortality between the groups. Though these results indicate that screening is unnecessary, the study has a number of limitations, namely dated diagnosis and treatment techniques owing to a protocol developed almost two decades ago. Regardless, the findings show a need to evaluate the benefits and consequences of undergoing treatment for prostate cancer, weighing the likelihood of disease progression and mortality with the negative side effects on urinary, bowel, and sexual function. Further follow-ups with longer term mortality data are needed to improve our understanding of this decision-making process to better inform clinicians and patients.
Written By: Wesley Tin, BMSc