What to expect after prostate cancer treatment

Study reveals what men can expect after prostate cancer treatment

One in eight men will receive a prostate cancer diagnosis in their lifetime and have to choose which treatment option is right for them.

For decades, this has meant making decisions with far too little information on what to expect from treatment — especially regarding effects on sexual function and urinary, bowel and hormonal health.

According to Dr. Bashir Al Hussein Al Awamlh, a fellow in Urologic Oncology at Vanderbilt University Medical Center (VUMC), “Many men with localized prostate cancer survive for 15 years or more, with minimal differences in survival among various treatment strategies.

“Given this long-time horizon and similar survival rates, the choice of treatment for patients may be influenced by the adverse effects of the treatments.”

He and others involved in the study hope the results of the decade-long study may help men feel more empowered when making treatment decisions along with their doctors.

Treatments for men with a favorable diagnosis

The CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation for Localized Prostate Cancer) study, coordinated by VUMC, is a multisite research study conducting long-term follow-up on men who were diagnosed with localized prostate cancer between 2011 and 2012.

The study included 2500 men who were divided into two groups: favorable prognosis and unfavorable prognosis, which is relevant because patients with an unfavorable prognosis receive more intensive treatments.

Men with a “favorable” prognosis can choose from four treatment options:

Active surveillance – When a man chooses active surveillance, he receives no treatment. Instead, his cancer specialist will closely monitor the tumor, moving to treatment later if necessary. This option is also known as watchful waiting.
Nerve-sparing prostatectomy – In this case, a man with prostate cancer undergoes a surgical procedure in which the prostate is removed, but the nerves involved in erectile function are left intact. The goal is to maintain as much sexual function as possible.
External beam radiation therapy (EBRT) – EBRT uses daily radiation to kill off cancer cells.
Low-dose-rate brachytherapy – Like EBRT, this treatment option utilizes radiation. However, instead of daily treatment, radiation ‘seeds’ are implanted in the prostate.

The research revealed that men who chose prostatectomy (prostate removal) experienced worse sexual function three to five years after the procedure compared to men who opted for other treatments.

Additionally, men who were given a prostatectomy were also more likely to live with urinary issues, with a quarter of these patients reporting “leakage” up to 10 years after the procedure. This is a significant percentage considering that only 4-11% of men who underwent EBRT instead of a prostatectomy experienced the same issues.

Treatments for men with an unfavorable diagnosis

Men with an “unfavorable” prognosis generally only have two treatment options since they require more aggressive treatments.

Options for men in this category included:

Prostatectomy – Like in the favorable group, this treatment involves full surgical removal of the prostate.
EBRT plus androgen-deprivation therapy (ADT) – Men in who receive an unfavorable diagnosis may choose to undergo EBRT, but with the addition of ADT, which lowers a man’s levels of circulating hormones. This is done to try to boost the effectiveness of the radiation.

As you can imagine, side effects are more likely in this group due to the aggressive treatment levels.

The research showed that like with the favorable prognosis group, a quarter of the men who chose to undergo a prostatectomy had urinary leakage.
EBRT/ADT led to worse outcomes for bowel and hormonal issues at 10 years post-treatment. Unfortunately, ADT also raises a man’s Alzheimer’s and dementia risk.
For men in the unfavorable group, doctors saw no differences in sexual function whether they received a prostatectomy or treatment using EBRT/ADT.

Arming yourself in the battle against prostate cancer

The good news is that with the results of this study, men can now make a more informed decision on care following diagnosis.

The authors plan to develop a personalized, patient-facing prediction tool using their findings to offer functional estimates through 10 years, based on different treatment strategies, to aid patients in making decisions.

“The findings underscore the importance of counseling men with unfavorable prognosis prostate cancer differently than favorable prognosis cancer regarding expected long-term functional outcomes and suggest that adverse effects of treatments on sexual function may be deemphasized in decision making for some men,” said senior author Daniel Barocas, MD, MPH, professor and executive vice chair of Urology at VUMC.

Outside of the realm of conventional medical treatment are lifestyle factors that may have a positive impact on the prostate cancer battle at home. These include:

Following the Prostate Diet – The Prostate Diet offers eight dietary principles that can help avoid a prostate cancer diagnosis.
Staying active – Studies show that even a single exercise session can help slow prostate cancer progression so staying active is a must.
Drinking green tea – According to the results of a study published in the journal Cancer Prevention Research, men with prostate cancer who consumed the active compounds in green tea demonstrated a significant reduction in serum markers predictive of prostate cancer progression.
Eating cruciferous vegetables – Broccoli, kale, cauliflower and Brussels sprouts are among vegetables rich in a phytochemical known as DIM (3,3’-diindolylmethane). DIM has been shown effective in inhibiting an enzyme involved in prostate cancer cell growth and in inducing cell suicide (apoptosis) while not impacting healthy cells. Cruciferous vegetables also harbor indole-3-carbinol (I3C), a phytochemical that protects DNA from damage, promotes apoptosis, and prevents growth of cancer cells.