Radiotherapy measured against surgery for prostate cancer treatment side effects

Men who have an advanced form of radiotherapy instead of surgery for prostate cancer may suffer fewer side effects, a new study suggests.

One scientist suggested that the specific type of radiotherapy could be a “kinder” treatment option for some patients.

The study found that urinary and sexual side effects were less likely after two years.

But they were more likely to suffer minor bowel problems compared to those who had surgery.

The new study, led by scientists at the The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, is the first to compare the long-term side effects of stereotactic body radiotherapy (SBRT) versus surgery in patients with early-stage prostate cancer.

Experts examined 109 men getting treatment at 10 UK cancer centres – with 50 men randomly assigned to get laparoscopic or robotically assisted surgery and 59 had radiotherapy treatment.

The men, who had an average age of 66, reported any side effects two years later.

Those who had the radiotherapy treatment reported better urinary continence and were less likely to report problems with their sex lives compared to those who had surgery.

Just 4.5% of those who had radiotherapy needed urinary continence pads after two years, compared to 47% of the surgical group.

But they did report more “bowel bother” after two years compared to the group who had surgery, according to an abstract of the study, which is to be presented to the 2023 ASCO Genitourinary Cancers Symposium.

Some 15% of the radiotherapy group reported minor bowel problems compared to none of those who had surgery.

Study chief investigator, Professor Nicholas van As, medical director and consultant clinical oncologist at The Royal Marsden NHS Foundation Trust and professor in precision prostate radiotherapy at The Institute of Cancer Research, London, said: “This world-first study reveals that SBRT, an advanced form of radiotherapy now widely available across the UK, is often kinder and can mean less long-term side effects than surgery for prostate cancer patients.

“One of the biggest concerns for men I see in clinic ahead of treatment for prostate cancer is whether it will make them incontinent, and many worry about the impact on their sexual function too.

“While there is a risk both SBRT and surgery will cause problems, these results suggest SBRT is less likely to.

“Going forwards, these results should support clinicians in facilitating important discussions with prostate cancer patients about whether to opt for SBRT or surgery, helping them make an informed decision based on their individual needs and concerns.”

Professor Emma Hall, co-director of the Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, added: “This important trial uses patient-reported outcomes to understand how various treatments for prostate cancer affect patients following recovery.

“It’s great to see that using SBRT for early-stage prostate cancer can help people avoid sexual and urinary side effects that are commonly associated with surgery, and I hope these findings will help men decide, with their clinician, the best course of treatment for them.”

The Royal Marsden use a machine called a CyberKnife to deliver this kind of precision radiotherapy, which is delivered to patients in five high-radiation doses over one-to-two weeks, rather than standard radiotherapy which delivers moderate doses through approximately 20 sessions over four weeks.

The hospital has two of the machines, which were funded by The Royal Marsden Cancer Charity.

Alexander Szczerbiuk, 73 from Morden, in south-west London, had the treatment in 2017 after a prostate cancer diagnosis and enrolling in the trial.

“In terms of treatment, you couldn’t wish for anything better,” he said.

“It was only two months from my diagnosis to the last of my five CyberKnife sessions, and I was pleased as punch everything happened so quickly.

“Before the treatment, my biggest concern was incontinence, as I really couldn’t bear the thought of having to use urinary pads.

“I was delighted to be selected for CyberKnife which, as a minimally invasive option, was a no-brainer.

“Fortunately, the side effects have been minimal and, while I experience rectal bleeding very occasionally, I urinate normally and have never needed to use a pad.”

Colin Maskell, 71 from Sutton, was also diagnosed with prostate cancer in 2017 and received the same treatment during the trial.

“My treatment started in January 2018 and there was nothing to it really,” he said.

“I didn’t feel anything at all, and it was over after five 40-minute sessions.

“Finding out I had prostate cancer was daunting, but The Royal Marsden has been excellent and the treatment itself has barely impacted my life.”