We know the question of frequent overdiagnosis and overtreatment in patients with prostate cancer and, associated with biopsies and treatments, sometimes superfluous, the risk of severe side effects. Patients who are increasingly better informed and aware of these adverse effects are now taking a closer look at the different options available to them with one objective that appears to be major: to avoid incontinence and impotence, 2 adverse effects linked to surgery. and radiotherapy. According to this study presented at the 2018 National Cancer Research Institute (NCRI) Conference, patients recently diagnosed with prostate cancer say they would trade part of their chances of survival for a reduction in these side effects and a maintenance of their quality of life.
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Prostate cancer is the most common cancer in men, but in many cases the disease is slow growing, with a relatively good chance of survival even without treatment. Treatment may include surgery or radiation therapy, these 2 procedures can cause urinary incontinence and loss or deterioration of sexual function. Some patients will need several months to recover their urinary and sexual functions, others will need a second treatment. This study suggests that, while patients obviously hope for the longest possible life, they also attach importance to their quality of life and this factor can influence a decision that is intended to be increasingly well informed.
Lead author Dr Hashim Ahmed, Chairman and Professor of Urology at Imperial College London and Chairman of the NCRI Prostate Cancer Clinical Study Group explains: " Men with prostate cancer Early prostate cancer must choose between active surveillance, with regular health check-ups, and more invasive treatment, such as prostate removal or radiation therapy. Previous research has suggested that:
- in men with low-risk prostate cancer, treatment does not improve 10-year survival;
- men with high-risk prostate cancer will, with treatment, be able to expect a 5% increase in 10-year survival;
- in men with average-risk disease, there is uncertainty about the effectiveness of treatment in prolonging survival to 10 years ”.
The question of side effects is essential because these include urinary incontinence, requiring the daily use of protections, loss of erectile function, despite drugs such as Viagra, and these effects affect self-esteem. and quality of life. Many patients affected by these effects as a result of treatment develop depression that severely affects their quality of life and their personal relationships.
Here, the study is conducted among 634 men with a recent diagnosis of prostate cancer, informed of their diagnosis and having received general information about their disease and possible treatments but still naïve to treatment. In all of these participants, the cancer had not yet spread. 74% had low or medium risk cancer, 26% high risk cancer. Participants were offered by their clinicians 2 different treatments in terms of likely impact on survival, incontinence, impotence, recovery time, and the possibility of further treatment. Participants were expected to participate in the treatment decision. Based on their responses, the researchers were able to assess the weight of each factor.
Survival remains the most important factor, but:
- the survival time factor is closely followed by the prevention of the risk of incontinence, the absence of additional treatment and the maintenance of erectile function;
- patients are willing to compromise between side effects and survival;
- on average, patients are willing to give up a 0.68% improvement in the chances of survival at 10 years in return for a 1% increase in the chances of maintaining their continence;
- on average, patients are willing to give up a 0.41% improvement in the chance of 10-year survival in return for a 1% increase in the chance of not needing further treatment;
- on average, patients are willing to give up a 0.28% improvement in 10-year survival odds in return for a 1% increase in being able to preserve erectile function.
So if the main motivation of the patient remains - logically - survival, these conclusions suggest an increasingly nuanced situation. Men are increasingly aware of the challenges and adverse effects of treatments and wish to avoid side effects as much as possible, to the point of accepting a lower survival rate to guarantee a low risk of side effects.
Thus many patients balance quantity and quality of life , and they should not have the feeling of "thinking badly".
“ I am interested in strategies that reduce harm to patients and limit the impact of treatments in terms of side effects impacting quality of life. For many patients, this means opting for active surveillance or less invasive treatments ,” concludes the lead author.
