Alberto Briganti, MD
Men with low-risk prostate cancer who chose active surveillance (AS) reported a higher quality of life (QoL) than men who chose direct active treatment such as surgery or radiation, according to a long-term study comparing AS, immediate curative treatment, and a reference cohort of men without cancer.1
Results also indicate that QoL for men who follow AS is about the same for men without cancer. Further, men who chose AS had lower levels of anxiety with their decision for a median of 6.5 years, according to researchers from Erasmus University Medical Center in Rotterdam, Netherlands. Findings were presented at the European Association of Urology Congress in Munich, Germany.
Four groups of men were invited to complete a one-time QoL questionnaire, which addressed general health (SF-12), respondents’ self-rated health (EQ-VAS), generic anxiety (STAI-6), prostate cancer-related anxiety (MAX-PC, for AS only), and urinary, bowel, and sexual function (EPIC).
The groups consisted of 121 men who followed a structured AS protocol (PRIAS), 74 men who underwent radical prostatectomy (RP) between 2007 and 2011 in the context of a screening study (ERSPC Rotterdam), 232 men who underwent radiation therapy (RT) at the Erasmus Medical Center, and a reference group of 204 men without prostate cancer who were age-matched to the AS, RP, and RT groups.
The AS group reported better urinary function (100 vs 83, P
= <.001), less urinary incontinence (100 vs 75, P
= <.001) and better sexual function (44 vs. 6, P
= <.001) than men who underwent RP. These differences were also clinically relevant. When comparing AS with RT, a statistically significant and clinically relevant difference in favor of the AS group was seen regarding sexual function (44 vs 18, P
Response rates for the AS, RP, RT and reference group was reported as 73% (121/166), 67% (74/111), 67% (232/348), and 75% (204/273), respectively. Median ages of men ranged from 73 to 76. Men on AS were more often highly educated and still employed, which was likely age-related.
“We found that men on active surveillance experienced better prostate-related health than men who underwent radical prostatectomy and radiotherapy. This showed up as better urinary function, less urinary incontinence, and better sexual function,” Lionne Venderbos, PhD, Department of Urology, Erasmus University Medical Center, said in a statement. “Men on active surveillance still live with untreated cancer as compared to men in the reference group who do not have cancer. The monitoring combined with information on the low-risk nature of men their disease may partly explain the similar quality of life.”
Prostate cancer is common in men over the age of 55. Men who choose active surveillance for their non-aggressive, slow-growing tumors avoid unnecessary treatment as well as side effects of the treatment, namely incontinence and impotence.
“When considering active surveillance, men should try to imagine whether living with untreated cancer would cause any stress, or that the follow-up visits lead to stress instead of reassurance,” said Venderbos.
“While we could have anticipated overall lower sexual and urinary function in men treated with surgery or radiation therapy as compared with men receiving AS, it is interesting to note that the long-term quality of life of men on AS was comparable to that of men without prostate cancer,” Alberto Briganti, MD, section editor of European Urology Focus and member of EAU Scientific Congress Committee said in a statement. “We also need to note that it is possible that patients choosing AS may be less disposed to accept any form of treatment, and this might be difficult to uncover via the retrospective comparisons of validated questionnaires.”
“When choosing treatment, it is important that men think about the potential side effects that are related to immediate curative treatment, like becoming incontinent or losing the ability to have an erection,” said Venderbos. “Balancing the advantages and disadvantages based on type of treatment, will make that man choose the type of treatment that fits his wishes and preferences best.”
1. Venderbos LDF, Aluwini SA, Roobol MJ, et al. Quality of life of men on active surveillance for prostate cancer versus men without prostate cancer: Are there any differences? Presented at: European Association of Urology Congress; March 11-15, 2016; Munich, Germany. Abstract 949.