Long-Term Adverse Effects and Complications After Treatment

The study started 12 years ago before many of the new radiation techniques were developed. It is really impossible to compare today with 12 years ago, but no one really knows until 12 more years ago by and a study is produced.

If someone today picks just IMRT radiation or standard SBRT (not MRIdian) then the study applies.

Doesn’t hurt to expose people to what long-term results could be.

My PSA was 6.1 when my journey started. 2 weeks later it was checked again at 6 .1 again. I underwent a biopsy and they found 6 out of 12 cores positive (all on the right side). Gleason 4 + 4. PSME showed no signs outside of prostate and, after having met with a radiation oncologist, I opted for RARP. Gleason was downgraded to 7, lymph nodes were all clear and I required no further treatment at that time.

However.......

During the PSME test, a 1.5 cm mass was found in my lower right lung. Guess you could say I was lucky to have developed PCa?

Downloaded and read the full report. As in any study one must first consider the Objective.

"To characterize long term treatment-related effects and complications in patients treated for PCA compared to a general population of older males."

10 complications were analyzed (see attached Fig 2 for results for each):
1) urethral stricture
2) placement of artificial urinary sphincter
3) placement of penile prosthesis
4) urinary incontinence
5) erectile dysfunction
6) radiation cystitis
7) radiation proctitis
8) bladder cancer
9) bladder cancer followed by cystectomy
10) rectal cancer

Interestingly the researchers chose this approach because earlier studies had only assessed a single institution or a single surgeon and did not include an untreated control group. Their "untreated group" included BOTH similarly aged men without PCa and men who had untreated PCa (on active surveillance).

The rational for comparing similarly aged untreated men, as a control, was because earlier studies, without such a control, OVERSTATE the risk of complications. This methodology "enables a comparison of rates of age-dependent functional changes, such as erectile dysfunction, which increase with age."

It means that "untreated men" will experience some of these complications, just because they are getting older; therefore, a true comparison requires that you adjust the risk accordingly.

In my mind, one limitation of this study is that it ONLY includes men who filed Medicare claims. Therefore, the average age of those in the study was ~66 y/o. The other thing I noted is that ~80% of the men were diagnosed (and presumably treated) before 2005. It seems to me that a lot has changed in treatment precision (particularly radiation), with what one would hope would result in reduction in side effects, as compared to almost 20 years ago. Unfortunately, it will take years before quantifiable statistics, regarding 12 year follow-up of large populations, is available for all the improved radiation treatment options currently available.

My main takeaway is buried deep in the study...at least ~38% of those undergoing prostatectomy and radiotherapy had a Gleason score of < = 6 and that percentage was probably much higher, since 45% of the treatment group was missing this data.

As many are aware, the debate as to whether to label GG1 (3+3) as something other than "cancer" is beginning to reach a consensus among the experts.
https://academic.oup.com/jnci/advance-article/doi/10.1093/jnci/djae200/7785749?login=false
https://www.urotoday.com/video-lectures/cancer-or-not-cancer-evaluating-and-reconsidering-gg1-prostate-cancer-cancer-gg1.html
I look forward to when men diagnosed with 3+3 GG1 will be told by ALL physicians, across the board, "You do not even have to consider the question as to whether to treat or not...relax...we will continue to monitor....."

@jeffmarc I agree with you. Given the decision process can be complicated and scary, I think it is also important for people to understand that the less exposure of healthy tissue to radiation because of a particular machine and margins, means potentially less side effects, maybe in the long term as well.