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FI V E Y E A R S A F TER treatment for loca lized prostate ca ncer, most side effects have waned, but differences in urinary and erectile function remain. T h a t 's a c c o r d i n g t o t h e l a t e s t results from the ongoing Comparative Ef fec t ivenes s A n a ly si s of Su rger y a n d R a d i a t i o n f o r L o c a l i z e d Prostate Ca ncer, or CEASA R , study ana lyzing long-term results in more than 3,600 men diagnosed with prostate cancer between 2010 and 2012. The study, published in JAMA in Ja nua r y 2020, may help physicia ns a nd patients better decide on which t reat ment opt ion s t o pu r sue a f t er a diagnosis. " S i n c e t r e a t m e n t o p t i o n s a n d treatment intensity vary based on cancer severity, we evaluated patient-reported function after treatment for favorable- risk prostate cancer separately from function after treatment for unfavorable- risk disease," said Karen E. Hoffman, MD, MHSc, MPH, the lead author of the study and an associate professor in the Department of Radiation Oncolog y at the University of Texas MD Anderson Cancer Center, in a press release. P a t i e nt s i n t h e s t u d y f i l le d ou t sur veys describing their side ef fects before treatment started, then repeated t he su r vey at si x mont h s, one yea r, t h r e e y e a r s a n d f i v e y e a r s l a t e r. Pa r t ic ipa nt s w it h f avor a ble r i s k s were treated with active sur veilla nce, ner ve-sparing prostatectomy, externa l bea m ra d iat ion t herapy ( EBRT) or low-dose rate brachy t herapy, whi le those with unfavorable risks received prostatectomy or EBRT with androgen deprivation therapy. It h a s be en c om mon ly obser ved that men have worse erectile function immediately after prostatectomy that improves over time, while radiation leads to a slower but noticeable decline — observations that the study confirmed, at least in the case of the favorable-risk group. However, the study showed men in the unfavorable-risk group had similarly disappointing erectile function f ive years out, no matter which treatment t hey received. A nd a l l pa r ticipa nts experienced overall declines. "For sexual function, all of the treat- ment options, even surveillance, were associated with significant declines," said senior author Daniel Barocas, MD, MPH, associate professor and Vice Chair of Urolog y at Va nderbi lt Universit y Medica l Center, i n a press relea se. "While the time course is different for surgery and radiation, our study shows that only about half of men undergoing these treatments who had erections good enough for intercourse before treatment will still have an erection good enough for intercourse five years later." CE A SA R now ha s f unding to con- tinue t he st udy a not her f ive yea rs. It a l so ha s a pred ic t ion model i n bet a version t hat may u lti mately prove a helpf u l addition to ma k ing decisions rega rding treatment pla ns. The st udy a lso fou nd t hat prost a- t e c t omy led t o more i nc ont i nenc e, compa red w it h ot her treatment s, i n bot h t he favorable a nd u n favorable g roups . However, i mprovement s i n bowel f u nct ion over t i me rema i ned c o n s i s t e n t a c r o s s t r e a t m e n t s . B r a c h y t h e r a p y p a t i e n t s r e p o r t e d worse continence-related side ef fects dur ing t he f irst yea r, compa red w it h p a t i e n t s w h o r e c e i v e d e x t e r n a l - bea m radiation . n Different Outcomes BY CARI WADE GERVIN A NEW STUDY MAY HELP MEN MAKE MORE INFORMED DECISIONS ABOUT PROSTATE CANCER TREATMENT. Different Men, 1 6