Patients with prostate cancer tend to live a long time after being diagnosed. In fact, according to the American Cancer Society, the five-year relative survival rate for the disease is approximately 97%, which could vary by the stage. With that, it is essential that patients must discuss potential long-term side effects and complications when deciding on a treatment protocol, explained Dr. Kiran Nandalur, a radiologist at Corewell Health in Grand Rapids, Michigan.
“Patients have a lot of choices when it comes to prostate cancer treatment; they can either undergo surgery or they can undergo radiation, they can undergo chemotherapy, or they can watch it,” Nandalur said in an interview with CURE®. “So for them for patients with prostate cancer, when they make their choice of therapy, what they really want to consider somewhat important is what are the potential complications are there, because they’re likely going to live a full life, which is great.”
Both radiation and surgery can be curative approaches for patients with prostate cancer.
Nandalur explained that approximately 30% of patients who undergo radiation, which is the most common treatment for prostate cancer, experience urinary symptoms.
Most of the time they are moderate — “very rarely are they severe, but they are bothersome,” he said, nothing that the most common long-term effects are frequency, meaning that patients have to urinate more frequently, and urgency, meaning the feel to urinate more. Prostate cancer survivors may also experience urinary incontinence, which is when urine leaks, after radiation, but that is more common after prostate cancer surgery, according to Nandalur.
Considering these side effects, patients should talk to their health care team to determine which treatment is best for them — if any. Wait-and-watch approaches, commonly referred to as “active surveillance” may also be a viable option for patients with low-risk disease, according to Nandalur.
READ MORE: Active Surveillance Once Again the Preferred Option for Low-Risk Prostate Cancer
“Before choosing any kind of prostate cancer treatment, we generally advise that patients talk to a urologist and the radiation oncologist and see what the best route for each individual patient is,” he said. “There’s a lot of strong data for low-risk patients that they can just watch (the prostate cancer), and it’s actually the management style now for those patients, which is excellent; it’s great that we can actually watch these prostate cancers with MRI is a PSA etc.”
When it comes time for treatment, Nandalur recently conducted research on determining which patients with prostate cancer are more likely to experience urinary symptoms from radiation. While MRIs may be helpful in predicting side effects, he’s hoping that in coming years, there will be a better ways that clinicians can detect which patients are at higher risk of these long-term side effects.
“For (patients with) prostate cancer specifically, improving quality of life is very important. And mostly it comes down again to urinary symptoms, and that’s where they have their challenges long term with both surgery and radiation,” he said. “We had some predictors for surgery previously, we’ve not had them for radiation and predicting side effects. So this (research) is a step forward for us, I believe. (There has been) some really promising data with genetics, and if we can combine this anatomic data that we have on this MRI, with that genetic information, maybe we can come up with a really comprehensive model that tells patients, Hey, this is your chance you’re going to have these side effects.’”
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