The adverse effects and complications after treatment for prostate cancer are ‘substantial’ and last for years, a large analysis has found.
It includes a seven times higher risk of urinary or sexual complications in men who had a prostatectomy compared with untreated men, the 12-year study found.
For men first treated with radiotherapy, the risk of such complications that was almost three times that of untreated men and this group also had three times the risk of a bladder cancer diagnosis.
Doctors need to make men aware of the risks before considering screening for the condition, the US-based researchers concluded in JAMA Oncology.
It comes ahead of an expected review from the UK National Screening Committee into several options for screening and whether PSA testing could be targeted to specific high-risk groups.
A study published in September had found that marked differences in PSA testing across Europe had not translated into differences in deaths from the disease and indicated overdiagnosis.
Researchers from the US SWOG Cancer Research Network looked at records from more than 29,000 men who had enrolled to one of two large National Cancer Institute prevention studies.
Of those, 3,946 had been diagnosed with prostate cancer, including 655 whose first treatment for the disease was a prostatectomy and 1,056 whose first treatment was radiotherapy.
Participants who had been diagnosed with prostate cancer but had not received treatment along with those who had not been diagnosed with prostate cancer, served as an untreated control group for comparison.
Using Medicare claims to assess for potential treatment-related complications, they looked for urethral stricture, placement of an artificial urinary sphincter, placement of a penile prosthesis, urinary incontinence, erectile dysfunction, radiation cystitis, radiation proctitis, bladder cancer, bladder cancer followed by cystectomy, and rectal cancer.
Those in the prostatectomy group had a 6.57 increased 12-year risk of having at least one of these 10 complications than untreated patients.
For men in the radiotherapy group, their 12-year risk of experiencing at least one of the 10 complications was 3.04 times greater than it was for those who had not been treated.
The incidence per 1000 person years of any one of the 10 complications was 124.26 for prostatectomy, 62.15 for radiotherapy and 23.61 for untreated participants.
The researchers concluded that given the uncertain benefit of prostate cancer treatment for most patients, the findings highlighted the importance of patient counselling before treatment and before screening.
Senior author Dr Ian Thompson from The University of Texas Health Science Center at San Antonio said: ‘This study throws down a major gauntlet to all physicians to give patients this information before they even begin the process of drawing a PSA test.’
It comes as the debate around PSA testing was reignited in the UK after Olympic cyclist Sir Chris Hoy called for the screening age to be lowered to 45 for people with a family history of the disease. He last month announced he was being treated for terminal prostate cancer.
In response, health and social care secretary Wes Streeting said he had asked the NHS to ‘look at the case for lowering the screening age on prostate cancer’.
The Department of Health and Social Care confirmed to Pulse that Mr Streeting was referring to a review already being done by the National Screening Committee into the evidence for targeted approaches to PSA testing as well as the Transform trial that was launched earlier this year on the best way to screen for the disease.
A report from the National Screening Committee that considers six different proposals for screening, including a targeted service for men at higher risk, is due to be published soon with a public consultation at the end of this year.
