Glossary
Localized prostate cancer: cancer only in the prostate; has not spread.
Prostatectomy: a surgical procedure to partially or fully remove the prostate.
Urinary incontinence: involuntary leakage of urine.
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Treatment Side Effects, Quality of Life Factors in Prostate Cancer
Key Takeaways
- Treatment choice for localized prostate cancer depends on cancer aggressiveness and quality-of-life factors, such as sexual functioning.
- Active surveillance is a safe option for appropriate patients, requiring vigilant monitoring to delay treatment.
It’s crucial for patients with prostate cancer to know that all treatments come with side effects, which may affect their quality of life.
Dr. Tyler M. Seibert spoke to patients with prostate cancer to discuss quality of life factors, such as sexual functioning during treatment.
Treatment options for patients with localized prostate cancer depend on how aggressive the cancer is, which opens conversations about quality of life.
At the CURE® Educated Patient® Prostate Cancer Summit, Dr. Tyler M. Seibert spoke to patients with prostate cancer about quality-of-life factors, such as sexual functioning, as they pertain to treatment options.
Seibert is an associate professor in the Division of Radiation Oncology at the University of California San Diego.
“When I was trained to treat prostate cancer, we said a lot of things that turned out to be somewhat inaccurate, and it was because we didn't really have the data to answer the right questions,” Seibert explained. “So we used to say, for example, that sexual function was much worse after radiation. I’m not saying that there’s no impact, but what we were looking at was really large studies.”
However, he emphasized that focusing on this kind of data wasn’t necessarily accurate for patients in the real world. Seibert noted that there were some problems with this approach. For example, surgery would be the go-to treatment option for men who were younger, had lower-risk prostate cancer and did not smoke. Men who had heart disease and were at risk for surgery tended to receive radiation, Seibert explained.
Treatment Approaches for Patients With Prostate Cancer
A common treatment option for patients with localized prostate cancer is active surveillance, said Seibert. This treatment approach is when doctors closely monitor the prostate cancer without providing treatments during this time, according to the Mayo Clinic.
“The first question is, is active surveillance safe? If there’s one thing I want everybody to understand is that it is very safe for the right patients,” he explained. “But it must be active, so you can’t just ignore the cancer and go away. You have to be monitored because most of these patients eventually need treatment, but they had years of no treatment.”
READ MORE: Next-Generation Imaging a ‘Gold Standard’ in Metastatic Prostate Cancer
Other treatment approaches, including prostatectomy and radiation therapy, may also be considered. Both approaches are “highly effective” at “getting rid of the prostate cancer,” Seibert clarified.
“They’re equivalent — it doesn’t really matter [which approach is used],” he explained. “I know this is a stressful decision, but you can’t really go too wrong because they’re both going to be effective.”
Nonetheless, some patients with higher-risk prostate cancer may require both surgery and then radiation, Seibert said, but “it’s important to assess that risk.” He emphasized that patients who may require this should talk to their doctors about their chance of needing radiation because the “side effects are worse if you need both.”
Side Effects and Quality of Life With Prostate Cancer Treatment
When considering the side effects associated with prostate cancer treatment, it’s important to note that some treatments may cause fewer side effects. However, “no therapy has no side effects,” Seibert explained.
Of note, Seibert described some of the common side effects that affect quality of life after surgery, radiation or both for patients with prostate cancer. These included urinary incontinence, waking up at night to urinate more than twice and changes in sexual functioning.
Urinary incontinence is a side effect that may occur after surgery or radiation, but more patients with prostate cancer who undergo surgery may need to wear a pad than those who underwent radiation, Seibert said.
Waking up at night to urinate two or more times is a side effect more patients may experience after undergoing radiation versus surgery in the long term. In a study published in The New England Journal of Medicine, patients with prostate cancer were more likely to experience this side effect during the first year since receiving treatment. At around six months, the side effect peaked, but became better after one year, the study showed.
Changes in sexual functioning were another common side effect experienced by patients who underwent prostate cancer treatment. Seibert noted that sexual functioning is better one year after treatment versus after six years in patients who received radiation versus surgery.
“I [want to] remind you that 12 years out, a lot of these patients are in their 80s. Even [patients who received] active monitoring eventually got treatment,” Seibert said. “But they’re declining in terms of sexual function over time.”
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