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Men who have recently been diagnosed with prostate cancer say they would exchange an improvement in their chances of survival against an improvement in side effects and quality of life, according to research presented at the Cancer Conference of the 2018 NCRI.
Prostate cancer is one of the most common forms of the disease in humans but, in many cases, it is a slow-growing disease, with a relatively good survival, even if it is not treated. Treatment may include surgery or radiation, but both can cause urinary incontinence and loss of sexual function. Some patients will recover from treatment for weeks or months and others may need a second treatment.
The new study suggests that, while patients attach importance to a longer life, they also attach importance to quality of life and may be willing to choose less treatment on that basis.
The study was presented by Hashim Ahmed, president and professor of urology at Imperial College London and chairman of the CNRI Prostate Cancer Clinical Studies Group. He explained: "Men with early prostate cancer must choose between active surveillance, with regular checkups and more invasive treatment, such as removal of the prostate or radiotherapy Previous research suggests that men with low-risk prostate cancer do not improve survival ten years after treatment Men with high-risk prostate cancer improve survival by 10% at 10 years with treatment In men with moderate-risk disease, there is uncertainty about whether treatment affects survival.
"Men who follow a treatment suffer from side effects, including urinary incontinence, requiring the daily use of pads, a loss of erectile function, despite the use of drugs such as Viagra, and some will require additional treatment.
"We know that men want to live longer, but many men become depressed after treatment and their quality of life and personal relationships are affected."
Professor Ahmed and his colleagues worked with 634 men who had recently been diagnosed with prostate cancer in British hospitals. The men had only been informed of their diagnosis and general information. They had not discussed any specific treatment with their clinicians yet.
In all cases, the cancer had not spread yet. Seventy-four percent had low or medium risk cancer and 26% had high risk cancer.
The men were presented with two different hypothetical treatments that differed in terms of likely impact on survival, incontinence, impotence, recovery time and the possibility of requiring additional treatment. Men were asked to choose which of the two hypothetical treatments they would choose, which was repeated several times, with varying effects on survival and side effects.
On the basis of men's choices, the researchers were able to quantify the average importance of each factor for men.
The results showed that survival was the most important factor, followed by the prevention of incontinence, the lack of additional treatment and the maintenance of erection.
However, they also suggested that patients were willing to compromise between side effects and survival. Men's choices suggest that on average they were willing to give up an improved chance of survival of 0.68% if this allowed them to increase by 1% their chances of retaining their urinary function. They were also willing to give up an improved survival chance of 0.41% in return for a 1% increase in the odds of not needing further treatment. For a one percent chance of being able to achieve erections, they were willing to trade a 0.28% chance of improving their survival.
Professor Ahmed said, "It is easy to assume that the main motivation of the patient is survival, but this study shows that the situation is more nuanced.Men want a long life, but they attach great importance to the development. Treatment points producing little side effects, On average, they were willing to accept a lower survival rate if the risk of side effects was low.The survival rate at what they were willing to accept is roughly equivalent to the small benefit they could expect from radical surgery or radiation therapy instead of active treatment.
"Every patient differs as to the treatment that he prefers but it can help them know that many men think about the balance between quantity and quality of life, and they should not have the feeling that it's wrong to have similar thoughts. "
"I am interested in strategies that reduce the damage done to patients and limit the impact of treatments on side effects and quality of life." For many patients, this means opting for active surveillance or less invasive treatments. such as focal therapy. "
Focal therapy uses heat or cold to target cancer, as opposed to the entire prostate, to reduce side effects, but it is not available in all hospitals. The researchers did not gather information on the treatments ultimately chosen by the patients, in part because the actual options available varied from one hospital to another.
Professor Ahmed said that more research was needed on less invasive treatments, such as focal therapy, and on ways to improve active surveillance using imaging rather than biopsies at the same time. repetition.
Robert Jones is Chair of the CNRI Prostate Cancer Subcategory of Clinical Trials, Professor of Clinical Cancer Research at the University of Glasgow, and did not participate in the research. "This research shows that patients are willing and able to compromise between different aspects of treatment and that they may wish to choose treatments or strategies that have fewer side effects, even if survival is less." Clinicians need to make sure that they give unbiased information about the different prostate cancer treatment options to help patients choose what is best for them. "
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