Prostate Cancer Treatments Carry Substantial Long-Term Risks: Study

A new study finds that medical guidelines do not provide enough information on these risks to help patients make informed decisions.

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A new study has found long-term risks associated with common prostate cancer treatments.

The research, published on Nov. 7 in JAMA Oncology, analyzed data from nearly 52,000 men. Those undergoing prostatectomy, the surgical removal of all or part of the prostate, faced a more than sevenfold increase in the risk of urinary and sexual complications compared with untreated men over 12 years, according to the results.

These complications include urinary tract infection, loss of bladder control, erectile dysfunction, and narrowing of the urethra or the neck of the bladder.

Radiotherapy patients also saw a nearly threefold increased risk of these side effects, as well as a tripled likelihood of developing bladder cancer.

Prostate Removal Raises Risk of Complications 6-Fold

The findings indicate that men who underwent prostatectomy faced a risk of experiencing at least one complication that was more than six times greater than that of untreated participants. Those treated with radiotherapy had a 12-year risk of complications approximately three times greater.

“This study throws down a major gauntlet to all physicians to give patients this information before they even begin the process of drawing a PSA (prostate-specific antigen) test,” senior author Dr. Ian M. Thompson Jr. of Christus Santa Rosa Health System and the University of Texas Health Science Center at San Antonio, said in a statement.

Joseph Unger, lead author and associate professor at the Fred Hutchinson Cancer Research Center in Seattle, emphasized that past studies have had small sample sizes, limited follow-up, or no valid control group, shortcomings this new data-rich analysis aims to address.

The analysis, conducted by the SWOG Cancer Research Network, points out how important it is for patients to be informed about these risks before a PSA test, which measures blood levels of prostate-specific antigen, the researchers wrote.

Balancing Risks and Benefits of Treatment

According to SWOG, the U.S. Preventive Services Task Force advises the approximately 30 million men in the United States aged 55 to 69 to discuss PSA testing with their doctors. Researchers point out that making informed treatment decisions requires a comprehensive understanding of both the potential risks and benefits associated with screening and subsequent procedures, which may include biopsies and various treatments if prostate cancer is diagnosed.

One difficulty in assessing the risks of adverse treatment effects stems from the increased incidence of issues such as erectile dysfunction that correlate with aging, the researchers noted. Accurately determining risk levels would necessitate comparisons between treated men and similarly aged untreated men from the general population.

Increased Risks Associated With Surgical Treatment

The study also compared men who opted for active surveillance instead of immediate treatment after a prostate cancer diagnosis with men without a diagnosis to evaluate the incidence of potential treatment-related complications, including urinary incontinence, erectile dysfunction, and bladder cancer.

​Given the uncertain benefits of prostate cancer treatment for many patients, the researchers stress the importance of patient counseling regarding screening and treatment options.​ They advocate including quantitative information on the risks and benefits of prostate cancer treatments in national cancer screening and treatment guidelines.