Prostate cancer is a disease about which many physicians and patients have developed a “cavalier” attitude. The disease itself has far-reaching, worrisome, oftentimes fatal consequences, but professionals and their patients don’t give these the attention they deserve. After treatment, there are long-term, worrisome and annoying complications of which many patients are not aware until they are present post-treatment. The patient is left to deal with urinary incontinence, erectile dysfunction, radiation cystitis, radiation proctitis, and recurrent urinary tract infections which prior to treatment were not present. These consequences of treatment were not expected by many patients, and are factors of which a patient being evaluated for prostate cancer should be informed.
To that end, studies have been done to compare the results after treatment to the outcomes of patients not treated. Over a 10+ year period, 3946 prostate cancer patients were evaluated for 10 treatment-related complications. 655 patients had prostatectomy, 1056 had radiation therapy, and the remaining 2235 received no treatment, or hormone therapy.
At 12 years, men who had prostatectomy were 7.23 times more likely to have urinary or sexual complications than non-surgery patients. Radiation therapy patients were nearly 3 times more likely to likely to have ED or incontinence, and were 100 times more likely to have radiation cystitis or proctitis than non-radiation, non-surgery patients. The incidence of any treatment-related complication was greatest with prostatectomy, half as frequent with radiotherapy, and negligible for patients with no aggressive treatment. These studies present a case for showing that the treatment of prostate cancer has worse after-effects than for patients left untreated.
What this report doesn’t say is did the patients treated with surgery or radiation live longer than treated, or not treated, otherwise. That would be helpful to know. What this report does say, however, is certain treatments for prostate cancer have poorer end results afterward than if that treatment were not done—especially, prostatectomy. The conclusion states that men suspected of, or proven to, have prostate cancer need to be informed of these unpleasant outcomes before they embark on the road to diagnosing prostate cancer. Available treatments have worse outcomes for patients than no treatment at all. Prostate cancer is slow growing, but it does metastasize. Local, confined disease is not difficult to deal with, but metastatic disease is problematic.
The bottom line is consider the treatment outcomes mentioned here and weigh them against the affects experienced with no treatment. You may decide time and observation are better than a life of diapers and wet pants.
References: Lennon K. Prostate Cancer Treatment Associated With More Complications Medscape Medical News 2024 November 7.
Unger JM, Till C, Tangen CM. Long term adverse effects and complications after prostate cancer treatment. JAMA Oncol 2024 Nov 7.
