The long-term side effects of prostate cancer treatment
Today’s State-of-the-Art Lecture will highlight the timing, spectrum and challenges of common long-term adverse effects after radiation treatment in patients with prostate cancer.
Prostate cancer patients are one of the largest groups of cancer survivors in North America. More than 95% of patients with localized disease will have a cancer-specific survival of 15 years after treatment; almost 80% of patients will experience 20 years of cancer-specific post-treatment survival.
“Yet, most of the side effects of prostate cancer treatment we talk about with patients are urinary incontinence, erectile dysfunction and sometimes bowel dysfunction, which are primarily related to the short-term functional outcomes,” said Keith Rourke, MD, FRCSC, professor in the Division of Urology, Department of Surgery at the University of Alberta. It’s time to expand the scope of the conversation.
In today’s State-of-the-Art Lecture, “A Perfect Storm: The Timing, Scope and Spectrum of Radiation-Induced Complications After Prostate Cancer Treatment,” Dr. Rourke will discuss 15- and 20-year follow-up data on adverse events prostate-cancer-treatment patients are likely to experience after treatment.
“We know the outcomes in terms of cure are likely equivalent between surgery and radiation, and that adverse events after surgery more or less stabilize at about five years, but as you follow people 10 and 15 years out, there’s a unique side effect profile that often emerges in patients after radiation treatment,” Dr. Rourke said.
Beyond incontinence and sexual dysfunction, radiation-specific conditions can arise, such as urethral stenosis and dystrophic calcification of the urethral and bladder wall, and particularly devastating complications, such as fistulae.
“When these radiation complications occur, they tend to be multifocal as well as delayed in onset. Moreover, patients who experience urinary tract injury from radiation have higher rates of antidepressant use and mental illness potentially due to an unawareness of these adverse events,” Dr. Rourke said.
The insidious nature of these complications, combined with the multifocality and general unawareness of them, can create the "perfect storm" of clinical expectations and challenges. The conversations you have with patients today can minimize the chances of that happening.
“Ethically, it behooves us to discuss the potential adverse events of prostate cancer treatment patients may experience not only in the short-term, but also in the long-term, so they can make a truly informed treatment decision,” he said.
Be prepared to come away from today’s presentation with a clear idea of the spectrum of short- and long-term prostate cancer treatment complications to discuss with your patients.
“Full disclosure of all potential risks and complications, particularly in the long-term with prostate cancer, is a key component of informed consent,” Dr. Rourke said.
