Prostate cancer treatment type strongest predictor of complications

The type of primary treatment received for prostate cancer-surgery or radiation therapy-is the strongest predictor of lesser-known complications such as the need for additional surgical procedures and development of secondary cancers, according to the authors of a recently published study from the University of Toronto.

In addition, increasing age and the level of pre-existing comorbidities at the time of either treatment were associated with higher rates of complications.

“This is the first, large-scale study of over 32,000 men to examine rates of other important complications associated with primary treatment, beyond the well-known ones of incontinence and erectile dysfunction, that can substantially affect a patient's quality of life,” said first author Robert Nam, MD, of the Sunnybrook Odette Cancer Center and the University of Toronto.

The study was published in The Lancet Oncology (2014; 15:223-31).

Dr. Nam and colleagues used five outcome measures or procedures specifically needed to address complications due to treatment: hospital admission rates, urologic procedures rates, rectal or anal procedures rates, open surgical procedure rates, and development of new, second cancers.

Conducted in collaboration with radiation oncologists, the study found that increasing age and level of pre-existing medical conditions at the time of radiotherapy or radical prostatectomy were associated with higher rates of complications.

The strongest predictor of these complications was the type of treatment received. Patients treated with radiotherapy had fewer minimally invasive urologic procedures, but had higher incidence of complications in all other categories of hospital admissions, rectal or anal procedures, open surgical procedures, and secondary cancers.

After accounting for differences of age and comorbidity, patients who underwent radiotherapy experienced two- to 10-fold higher rates of these types of complications compared to those who had surgery. Higher rates from the radiotherapy group included complications such as being admitted to hospital to treat bladder or rectal bleeding, or to undergo major operative procedures such as cystectomy.

The cumulative incidence of secondary cancers in years 5 to 9 was 4.5% in the radiotherapy group and 1.8% in the surgery group.  The most common site of secondary cancers was the gastrointestinal tract.  When comparing cancer incidence rates to the general population, the younger patients in the radiotherapy group experienced up to a 3.5-fold higher rate of developing secondary cancers, while rates in the surgery group were the same as for the general population.

Of the 32,465 patients, 15,870 underwent surgery with a median age at 62 years, and 16,595 had radiotherapy with a median age of 70 years.

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