Long-Term Adverse Effects and Complications After Treatment

This study is excellent! Thanks for posting!

Besides defining differences in the types and probabilities of encountering various side effects after surgery and radiation treatment, it also defines the advantages of choosing active surveillance for men initially diagnosed with low or favorable intermediate risk PCa.

From the study:

“Conclusions and Relevance: This cohort study found that, even after accounting for age-related symptoms and disease, PCA treatment was associated with higher rates of complications in the 12 years after treatment. Given the uncertain benefit of PCA treatment for most patients, these findings highlight the importance of patient counseling before PCA screening and treatment and provide a rationale for pursuing opportunities for cancer prevention.“

Turns out that (see article below):

“Participants who had been diagnosed with prostate cancer but had not received treatment (because this cancer tends to grow slowly, many men choose active surveillance), along with those who had not been diagnosed with prostate cancer, served as an untreated control group for comparison.”

“The authors argue that given the uncertain benefit of prostate cancer treatment for most patients, these findings highlight the importance of patient counseling before treatment and before screening.”

Finally, a large, long term study that quantifies the benefit of choosing AS over surgical or radiation treatment in cases of low or intermediate risk PCa!
https://www.swog.org/news-events/news/2024/11/07/long-term-risks-prostate-cancer-treatment-detailed-new-report

I do have a problem with this statement in the report

“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 test,”

Since the vast majority of people getting that test won’t have anything to worry about, giving everyone all that information, about drawbacks and risk of treatment ahead of time, is really not going to be at all useful to most men.

Understand how that statement could be interpreted as a pejorative call of repentance towards physicians, when it may have been better aimed at the more nebulous “medical-industrial establishment”.

Even so, the best investment advise must include disclaimer statements.

Richard Ablin, who discovered the prostate-specific antigen (PSA), has expressed concerns about its use in widespread screening for prostate cancer. He argues that the PSA test is unreliable and has been misused, leading to overdiagnosis and overtreatment. Ablin believes that the test should not be used as a general screening tool for all men, as it can result in unnecessary treatments and complications without significantly improving outcomes.

IMHO PSA screening may have been “better than nothing” in years gone by; however, there are now much more specific and reliable non-invasive tests that could be used for PCa screening, which would be just as cost effective if scaled to screening volumes.

Others may know better, but I think ultrasensitive PSA testing is still considered a very effective method for monitoring men after radical prostatectomy, as it provides a significant lead-time advantage in detecting biochemical recurrence…probably a better use of PSA monitoring.

The thing is when somebody has a high PSA they do a biopsy. If the biopsy doesn’t show anything above a Gleeson six then they don’t recommend anything be done right away

If doctors went straight from high PSA to surgery or radiation that would be a different story, but that is not what is happening

Not sure about “somebody”, but in my case when my PSA level came in at 7.8 I was referred to a urologist whose first recommendation was to do a mpMRI.

It was only after the mpMRI found three lesions (PIRADS 3, 4 and 5) that my urologist recommended a targeted fusion biopsy.

That should be standard practice.

If a doctor recommends a biopsy, solely based on an elevated PSA level, it’s time to head for the door and run!

Very misleading and discouraging study IMHO. They used men with Gleason 6’s AND men who did NOT have prostate cancer as a comparison?? WTF? That’s like comparing the complications associated with amputation of a gangrenous limb with those who had NO INFECTION!!
Of course men who have had treatment will have higher rates of complications - how can they NOT??
I am now in salvage radiation knowing full well that the radiation could cause my previously treated bladder cancer to return even more aggressively. Does that mean I do nothing for the prostate cancer?
Until you get a crystal ball along with your medical degree there is no way to know if your treatment decisions are right or wrong, good or bad or more harmful than not.

I am really puzzled by your comments. The study I posted compared people who had radiation with people who had surgery. Maybe the second study discussed people without active cancer, that wasn’t what the first post discussed.

It came up with conclusions about side effects for those two different types of treatments after 12 years.

People who didn’t have a seven or above, weren’t really involved in that survey, which discussed just results of treatment. The results section doesn’t even mention people that don’t have prostate cancer or people that weren’t treated.

Somehow I was able to access the Full Text this AM. Can’t do it now. But they included not only patients with Gleason 6’s, but also patients who did NOT have PCa of any kind.
So my point was: of course there will be complications in those men TREATED. How could there not be? No treatment for anything is always the best treatment.
And there are differences in those complications depending on the treatment chosen. Maybe the surgery vs radiation is apples to apples, but the comparison of overall complications in both groups in toto cannot be compared to men either untreated or without cancer.
Perhaps I’m splitting hairs or maybe I EXPECT complications, no matter how successful the treatment.

One of these studies was posted a couple of days ago and the second study seems similar in its generality and lack of machine specifics, margins used and built in MRI and as such, the post I made is still a valid opinion:

As a layman, I don't think this study proves anything other than after 12 years one can still feel the side effects of removal or radiation. With all do respect, it strikes me as misleading. Their data set included both those that had radiation and those that had their prostate removed. There data collection made no comparisons from one radiation machine to another (or for that matter the type of prostate removal that was done) but instead seemed to say, without addressing any form of radiation, the type of machine, the margins used that impact healthy tissue, that one could have more problems than people who were untreated, after a 12 year period.

I believe that with radiation, how much healthy tissue is exposed to radiation matters. Margins matter, and so do possible microcells, which is why the standard of care for many types of radiation includes the entire prostate plus a margin.

Without including the types of radiation machines, radiation methods and types of prostatectomies, the study conveys an incomplete conclusion that one better watch out, even after 12 years, for bad side effects. I was treated with the Mridian narrow margin built in MRI radiation machine and finished in 2023 with minimal symptoms. Potential microcells notwithstanding (which is one reason why we all continue to test), I would be surprised, if I am alive at 82, that I would be feeling new symptoms or exacerbated symptoms at that time. I am not sure but we will see. Certainly our treatment choices can have a short, medium and long term effect but I believe that is not in a trial/study vacuum that disregards technological advances.

One final thought regarding any study that does not include radiation machine type comparisons comes from the Mirage randomized trial study which concluded "In this randomized clinical trial, compared with CT-guidance, MRI-guided SBRT significantly reduced both moderate acute physician-scored toxic effects and decrements in patient-reported quality of life."

Exactly what my Urologist had me do.