James Kearns, MD, assistant professor of medicine, Levine Cancer Institute, Atrium Health, discusses adverse events (AEs) associated with surgery in patients with high-risk prostate cancer.

Maintaining a patient’s quality of life (QoL) is becoming a much more important endpoint in the treatment of prostate cancer, and Kearns says this is one reason why physicians need to have a conversation with patients before deciding if surgery is the right approach for them. Because surgery is not typically nerve-sparing in high-risk patients, they are likely to develop erectile dysfunction after the procedure. Continence rates tend to be lower, although this is not certain when treating those with “bulky” high-risk disease, Kearns adds.

Physicians often compare the AEs associated with surgery versus radiation therapy to determine which treatment approach to take for these patients. Physicians should consider if surgery will impact QoL and how the procedure will impact QoL in terms of their patients’ overall survival. If survival is being prolonged at the cost of serious QoL issues, this is something patients need to understand before a decision is made.

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James Kearns, MD, assistant professor of medicine, Levine Cancer Institute, discusses adverse events associated with surgery in patients with high-risk prostate cancer.

Dr. Kearns on AEs Associated With Surgery in Prostate Cancer

James Kearns, MD, assistant professor of urology, Levine Cancer Institute, discusses factors to consider when choosing treatment for a patient with prostate cancer.

When choosing an effective therapy for prostate cancer, physicians need to choose an approach that not only will prolong survival but will also help patients maintain their quality of life (QoL), says Kearns.

There are many treatments available, but a physician has to choose an approach that is individualized based on each patient’s disease characteristics. He adds that it is important to remember that every action will have side effects. For example, active surveillance for low-risk cancer can delay a patient’s risk for physical side effects, such as erectile dysfunction and urinary incontinence, but can increase the anxiety associated with having cancer that is not immediately treated.

Kearns notes that there have been several recent QoL studies comparing radiation therapy with surgery for the primary treatment of prostate cancer. Although in general, these patients have similar QoL, different domains of QoL have different levels, he says. As such, communicating these factors with patients to help them make better treatment decisions is imperative.

Dr. Kearns on Choosing Treatment for Patients With Prostate Cancer

James Kearns, MD, assistant professor of urology, Levine Cancer Institute, discusses the role of surgery in patients with high-risk prostate cancer.

Physicians have to decide whether surgery is the right option for patients on an individualized basis, Kearns says. It is an important conversation to have with patients, though some patients are inclined to opt for surgery, explains Kearns. An important factor is the patient’s risk tolerance. Because this is a high-risk population, it is expected that these patients will need further therapy down the line, whether it be radiation or hormone therapy. Physicians want to make sure that if patients undergo surgery, there is a good chance it will delay or eliminate the need for that future treatment. If later treatment is unavoidable, Kearns notes it is probably better to avoid the morbidity of surgery.

On the other hand, if a patient is skeptical about the procedure, it is important for the physician to outline the risks and benefits of surgery. However, Kearns adds that most patients seem to be willing to undergo the procedure.

James Kearns, MD

Articles

Dr. Kearns on AEs Associated With Surgery in Prostate Cancer

Dr. Kearns on Choosing Treatment for Patients With Prostate Cancer

Dr. Kearns on the Role of Surgery in High-Risk Prostate Cancer