Prostate Cancer Treatments Linked to Varying Outcomes, Study Suggests

Men undergoing radiation therapy for prostate cancer may face a higher risk of death and urinary complications compared to those who opt for surgical removal of the prostate, according to a study from the State University of New York. Conversely, surgery is associated with a greater likelihood of erectile dysfunction and urinary incontinence.

Prostate cancer is the most common cancer among men, with over 68,000 new cases diagnosed annually in the UK. For early-stage cancers that have not spread, both radiotherapy and radical prostatectomy are common treatment options. Surgery involves the physical removal of the prostate gland, which can impact a man's ability to conceive naturally. Radiotherapy uses high-energy radiation to target and destroy cancer cells without an operation.

The study, which analyzed medical records of over 20,000 men treated with either radiation therapy or a radical prostatectomy over approximately five years, found that men who received radiotherapy were 45 percent more likely to die from any cause during the follow-up period. Overall mortality rates were around 8 percent for those treated with radiation, compared to 6.5 percent for those who underwent surgery.

Researchers noted that men treated with radiation were also more prone to urinary retention, bladder inflammation, and blood in the urine. The study's lead author, Dr. Jeffrey Weiss, a professor of urology, stated that treatment decisions for prostate cancer are life-changing and that risks and benefits of each option must be carefully discussed with patients.

Surgical patients experienced higher rates of urinary incontinence, affecting 29 percent of those treated surgically compared to 6 percent of those receiving radiation. Around one-third of men who opted for surgery also developed erectile dysfunction.

The study, however, was observational, meaning it cannot establish a direct cause-and-effect relationship between the treatments and the observed mortality differences. The researchers emphasized the need for further investigation into prostate cancer-specific survival and recurrence rates.

The findings come amidst ongoing discussions about prostate cancer screening. Earlier this year, the National Screening Committee rejected proposals for a national screening program, citing concerns that expanded screening could lead to over-diagnosis and over-treatment, potentially exposing men to side effects like impotence and incontinence for tumors that might not have posed a threat during their lifetime.

Additionally, a separate study highlighted potential risks associated with androgen receptor pathway inhibitors, drugs often administered alongside radiotherapy. These drugs reduce testosterone levels, which can slow cancer growth but may also increase the risk of obesity, diabetes, and high blood pressure, particularly in older men, thereby elevating the risk of heart disease, liver disease, osteoarthritis, and other cancers.