Study results could form road map to guide prostate cancer treatment decisions

The 5-year results of a prospective, population-based study, involving more than 2000 men across the USA with localized prostate cancer, could form a road map for use by newly diagnosed prostate cancer patients to help guide their treatment choices and expectations.

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Researchers from Vanderbilt University Medical Center (VUMC; TN, USA) have released follow-up results from their prospective, population-based Comparative Effectiveness Analysis of Surgery And Radiation (CEASAR) for localized prostate cancer study. The results detail the 5-year health outcomes of 2005 diverse men from across the USA who received radiation, surgery or active surveillance treatment regimens for their prostate cancer. Investigators hope the data could help create a road map for use by newly diagnosed prostate cancer patients, guiding their treatment choices and expectations.

Senior study author Daniel Barocas (VUMC) stated: “We are providing information about the side effects of different treatments for prostate cancer that men and their providers can use to make treatment decisions.”

The study involved a total of 2005 men who were diagnosed with prostate cancer between 2011 and 2012. 1386 study participants had favorable risk prostate cancer – Grade 1–2 – and the remaining subjects had unfavorable-risk prostate cancer, Grades 3–5.

Men with favorable-risk prostate cancer chose to receive active surveillance, nerve-sparing prostatectomy, external beam radiation or low-dose-rate brachytherapy therapies. By contrast, men with unfavorable-risk disease underwent either prostatectomy or external beam radiation therapy in combination with androgen deprivation therapy.

Investigators employed the 26-item Expanded Prostate Index Composite to assess patients self-reported bowel, bladder and sexual functions every year for 5 years.

For men diagnosed with favorable-risk prostate cancer, compared with an active surveillance treatment regimen, nerve-sparing prostatectomy was associated with poorer urinary continence and sexual function at 5- and 3-years post treatment initiation respectively. External beam radiation therapy was not associated with any clinically different changes in bowel, urinary and sexual function over the course of the 5-year follow-up, compared with an active surveillance regimen.

For men with unfavorable-risk prostate cancer, combination external beam radiation therapy and androgen deprivation therapy was associated with poorer hormonal and bowel functions at 6 months and 1-year post treatment start respectively, when compared with prostatectomy. However, the combination treatment conferred improved incontinence and sexual function at 5 years.

Commenting on the research, David Penson, Chair of the Department of Urology at VUMC, stated: “This work provides critical and understandable information to patients and providers to help them make better decisions in localized prostate cancer.”

However, Barocas concluded: “…we have only illuminated one facet of a complex decision. There is more to a treatment decision than just the side effects, the most obvious being the effectiveness of the treatment, and that is something we hope to be able to demonstrate as we are now funded to look at 10-year cancer outcomes.”


Hoffman KE, Penson DF, Zhao Z et al. Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer. JAMA. 323(2); 149–163; (2020);

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Ilana Landau

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