Home Medizin Mehr Nebenwirkungen bei lokalen Therapien bei Prostatakrebs

Mehr Nebenwirkungen bei lokalen Therapien bei Prostatakrebs

von NFI Redaktion

A retrospective cohort study published in JAMA Network Open found that men with advanced prostate cancer who undergo local therapies such as radiotherapy or radical prostatectomy are significantly more likely to experience gastrointestinal, sexual, and incontinence problems in the subsequent years compared to patients treated systemically. Dr. Hubert Kübler, Director of the Clinic and Polyclinic for Urology and Pediatric Urology at the University Hospital of Würzburg in Germany, emphasized the ongoing debate over the role of local therapy in the standard treatment of advanced prostate cancer, which typically involves Androgen Deprivation Therapy (ADT).

The study, conducted by Saira Khan, PhD, MPH, Assistant Professor of Surgery at the Washington University School of Medicine in St. Louis, Missouri, and her colleagues, aimed to examine the impact of local therapy on the quality of life of men with advanced prostate cancer, given the relative survival advantage of such treatment. They emphasized that the side effects of local therapy in this context have not been thoroughly evaluated, making their study one of the first to do so.

The cohort study included 5,500 US veterans diagnosed with advanced prostate cancer between January 1999 and December 2013. The average age of the participants was 68.7 years, with 31% receiving local therapy and 69% receiving systemic therapy.

The study reported that the prevalence of side effects remained high regardless of the type of therapy received. Men who underwent local therapy reported experiencing gastrointestinal, sexual, and incontinence symptoms more frequently than those who received systemic therapy, even up to five years after treatment. Notably, the study’s authors acknowledged the challenge of reconciling the survival advantage of local therapy with the increased risk of these side effects, particularly in the context of advanced prostate cancer.

The study also highlighted discrepancies with prior research, including the recently presented PEACE-1 trial, which suggested that local therapy may reduce local complications and problems in high-risk patients. Dr. Kübler pointed out the limitations of the study, particularly in terms of evaluating subsequent interventions and patient outcomes in the later stages of the disease.

While the findings of this study may raise concerns about the potential side effects of local therapy in the context of advanced prostate cancer, Dr. Kübler emphasized the importance of informing patients about the expected side effects of such treatment, especially in light of the often marginal improvements in survival. He acknowledged the differences in patient demographics and healthcare settings between the US veteran population and the healthcare systems in Germany.

As clinicians, it is important to recognize and openly discuss the potential side effects with patients before considering local therapy for advanced prostate cancer. This approach ensures that patients are well-informed about their treatment options and emphasizes the importance of shared decision-making in managing advanced prostate cancer.

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