Research News: Treatment Options for Prostate Cancer

Rand: For men with prostate cancer, making decisions about treatment choices often includes weighing their options and considering the harms versus the benefits, plus what the latest research shows. AHRQ researcher Dr. William Lawrence is with us to explain a new AHRQ comparative effectiveness report on prostate cancer treatment. The report is the newest in AHRQ’s ongoing series of reports that use unbiased scientific evidence to make direct comparisons of health care treatments. Dr. Lawrence, welcome, thank you for joining us.

Dr. Lawrence: Oh, no problem.

Rand: Did the AHRQ’s report make any conclusions about different treatment options for prostate cancer?

Dr. Lawrence: It did. One important finding was that, for patients who choose surgery, outcomes may vary according to treatment settings. The evidence shows that patients who undergo complete prostate removals are less likely to experience urinary incontinence or other complications if the operation is done by an experienced surgeon in a hospital that does many of these procedures.

Rand: Can you put this disease into context for people. How common is prostate cancer and what is the risk of dying from it?

Dr. Lawrence: In 2007, about 218,000 men were diagnosed with prostate cancer, and about 27,050 men died from the disease. The lifetime risk of dying of prostate cancer remains about 3 percent.

Rand: And what about treatment risks?

Dr. Lawrence: All treatments can cause health problems, primarily urinary incontinence, bowel problems and erectile dysfunction. The chances of bowel problems or sexual dysfunction are similar for surgery and external radiation. Bother from leaking urine is at least six times more likely among surgery patients than those treated by external radiation. However, among patients who choose surgery, urinary complications and incontinence are less likely if their surgeons performed more than 40 prostate removals per year.

Rand: Dr. Lawrence, so what’s important to know if you or a family member has been diagnosed with prostate cancer and is now weighing treatment options?

Dr. Lawrence: First, it’s important to know that treatments for prostate cancer vary widely. This report aimed to look at the effectiveness and risks of eight treatment options, ranging from prostate removal to radioactive implants to no treatment at all. And it concluded that scientific evidence has not established that surgery or any other single treatment is superior for all men.

Rand: Then how do patients make the best treatment choices?

Dr. Lawrence: Again, there is no single superior treatment choice for everyone. In choosing, men should take into account their age, race, ethnicity, health status, family history, personal preferences and how quickly the cancer is likely to spread. Patients need to collaborate with their clinicians to choose the option that’s best for them.

Rand: Dr. William Lawrence, thanks for being with us.

Dr. Lawrence: My pleasure.