Over Treating Cancer? — For Men Like Ben Stiller, Who Received Prostate Cancer Surgery, Study Says Long-Term Side Effects Can Linger For Years

When Stiller was diagnosed, he happened to get a prostate-specific antigen test (PSA), which measures the prostate-specific antigen in the blood. An elevated PSA level in the blood does not always mean you have prostate cancer, but it does call for further tests. The “Zoolander” also underwent a biopsy, which revealed he had “mid-range aggressive” cancer.

Since he was at higher risk, Stiller had a prostatectomy. This procedure is an option for men with any risk group of prostate cancer that hasn’t spread outside of the prostate gland. During the procedure, the surgeon removes the entire prostate, along with some tissue around it, including the seminal vesicles that release fluid into the semen. Side effects may follow this procedure, which may include erectile dysfunction and urinary incontinence. However, how long these side effects may linger is what the CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation for Localized Prostate Cancer) study, coordinated by Vanderbilt University Medical Center, sought to answer.

The study followed roughly 2,500 men from diverse backgrounds in the United States. All of the men were diagnosed between 2011 and 2012 with prostate cancer and had received treatment.

Over ten years, the participants were closely monitored and asked to answer several questions regarding side effects related to urinary, bowel, sexual, and hormone therapy.

The participants were placed into two groups depending on their treatment plan. One group included patients treated with active surveillance, nerve-sparing prostatectomy, external beam radiation therapy (EBRT), and low-dose-rate brachytherapy.

Active surveillance is a “watch-and-wait” approach for men with low-risk prostate cancer, meaning you have a small number of cancer cells found in your biopsy, a low PSA, and a low-grade cancer. This approach is typically enough for men with low-risk prostate cancer. However, if you’ve been diagnosed with moderate-risk cancer, more may be needed.

WATCH: Understanding How Active Surveillance Works

Nerve-sparing prostatectomy surgically removes the prostate while protecting the nerves to minimize the side effects of erectile dysfunction. External beam radiation therapy uses high doses of radiation to stop cancer cells from dividing and shrinking tumors. Low-dose-rate brachytherapy is a form of radiotherapy.

The second group of study participants was treated with prostatectomy or external beam radiation therapy with androgen deprivation therapy (ADT), which combines radiation treatment with anti-hormone therapy, which reduces the male hormone androgen.

The study’s findings suggest that for “Men with localized prostate cancer (cancer confined to the prostate), radical prostatectomy was associated with a greater decrease in sexual function and urinary incontinence than either EBRT or active surveillance after three years and was associated with fewer urinary irritative symptoms than active surveillance; however, no meaningful differences existed in either bowel or hormonal function beyond 12 months or in other domains of health-related quality of life measures.”

For men with localized prostate cancer, radical prostatectomy was associated with “significant declines in sexual function” compared with EBRT and active surveillance. Urinary incontinence scores by participants also “declined significantly after surgery compared with EBRT and active surveillance.”

WATCH: A Healthy Sex Life Is Possible After Prostate Cancer

In addition to gauging possible long-term side effects of certain prostate cancer treatments, researchers say they hope their findings help patients and their care team fine-tune their treatment outlook.

“The findings underscore the importance of counseling men with unfavorable prognosis prostate cancer differently than favorable prognosis cancer regarding expected long-term functional outcomes and suggest that adverse effects of treatments on sexual function may be deemphasized in decision making for some men,” senior author Dr. Daniel Barocas professor and executive vice chair of Urology at Vanderbilt University Medical Center (VUMC) told the VUCM Reporter.

More on Prostate Cancer

Prostate cancer is the most common cancer in men. It starts in the walnut-shaped prostate gland between the rectum and bladder, producing the fluid that nourishes sperm. Fortunately, most prostate cancer is caught with screening examinations.

Prostate cancer does not always behave the same in every man it impacts. The cancer can be considered “low-risk” and can be slow-growing, and treatment might not be necessary. In other men, the cancer may grow faster or more aggressively, requiring more immediate treatment. Because of this, there is some debate about screening.

WATCH: What to Know About Prostate Cancer Screening

Symptoms of prostate cancer may include:

• Urinating more often
• Waking up in the middle of the night to pee
• Blood in your urine
• Trouble getting an erection
• Pain or burning when you urinate
• Pain in your back, hips, thighs, or other bones
• Unexplained weight loss
• Fatigue

Questions for Your Doctor

If you have experienced symptoms associated with prostate cancer or have a screening coming up, here are some questions you may ask your doctor:

• If I had elevated PSA levels, what could be causing that besides cancer?
• How long will it take to learn if my PSA levels warrant further testing?
• What are the treatment options that are best suited for me based on my risk level?
• What financial resources exist to help me with the costs associated with treatment?
• How long will my potential treatment prevent me from working or continuing normal activities?

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