PCORI-Funded Study Advises Patient Preference When Treating Prostate Cancer

Comparing the immediate and long-term impact of radical prostatectomy, external beam radiotherapy, brachytherapy, and active surveillance, a study published in JAMA recommends consulting patients on their individual preferences prior to making a treatment decision.

The study enrolled 1141 men (median age between 66 and 67 years) who were newly diagnosed with prostate cancer and compared their quality of life (QOL) following the 3 treatment options with active surveillance. The men—a majority (77% to 80%) of whom were white—were enrolled within 5 weeks of their diagnosis, between January 2011 through June 2013. QOL was assessed using Prostate Cancer Symptom Indices, pretreatment and at 3, 12, and 24-months post treatment. The instrument helps quantitate sexual dysfunction, urinary obstruction and irritation, urinary incontinence, and bowel problems (0 being normal function and 100 being maximum dysfunction).

A majority of men (469, 41.1%) underwent radical prostatectomy, followed by 314 (27.5%) who chose active surveillance, and 249 (21.8%) underwent external beam radiotherapy. A much smaller number (109, 9.6%) were treated with brachytherapy. The mean baseline scores for the group were:

• 41.8 to 46.4 for sexual dysfunction
• 20.8 to 22.8 for urinary obstruction and irritation
• 9.7 to 10.5 for urinary incontinence
• 5.7 to 6.1 for bowel problems

By 3 months, the mean sexual dysfunction scores worsened for men undergoing radical prostatectomy (36.2 [95% CI, 30.4-42.0]), external beam radiotherapy (13.9 [95% CI, 6.7-21.2]), and brachytherapy (17.1 [95% CI, 7.8-26.6]), when compared with men on active surveillance. Additionally urinary incontinence scores at 3 months were worse in men who chose radical prostatectomy (33.6 [95% CI, 27.8-39.2]), compared with active surveillance. Scores for urinary obstruction and irritation were higher with external beam radiotherapy (11.7 [95% CI, 8.7-14.8]) and brachytherapy (20.5 [95% CI, 15.1-25.9]), while and bowel symptoms were worse with external beam radiotherapy (4.9 [95% CI, 2.4-7.4]).

Importantly, however, the effects plateaued out by 24 months, such that the mean scores were not very different among the treatment groups versus active surveillance.

The comparative effectiveness method used in this study shows that contemporary treatment options were associated with distinct patterns of QOL changes, the authors write. The authors recommend that this information should be considered, and patients be consulted about their preferences, prior to making treatment decisions for prostate cancer.

Joe V. Selby, MD, MPH, executive director of the Patient-Centered Outcomes Research Institute (PCORI), included this study in his research blog on the PCORI website, highlighting the payback to the healthcare community from PCORI-funded research studies.

Reference

Chen RC, Basak R, Meyer AM, et al. Prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance and patient-reported quality of life among men with localized prostate cancer. JAMA. 2017;317(11):1141-1150. doi: 10.1001/jama.2017.1652.