Lengthening Our Perspective on Effects of Prostate Cancer Treatment

CEASAR researchers to extend the landmark clinical trial on treatment outcomes.

Results from the Comparative Effectiveness Analysis of Surgery and Radiation, or CEASAR study, shed light on physical and mental effects of prostate cancer treatment at five years. Now, under lead investigator Daniel Barocas, M.D., urologist at Vanderbilt University Medical Center, the CEASAR study will be extended to revisit participants ten years later.

Building on Initial CEASAR Results

Investigators from the original six-site study have published their results in JAMA, European Urology, The Journal of Urology, and others. They studied thousands of men diagnosed with clinical stage cT1-2 localized prostate cancer, diagnosed in 2011 or 2012. They compared functional outcomes and adverse events associated with different therapies.

They found radical prostatectomy was associated with greater declines in sexual function and urinary incontinence than external beam radiation or active surveillance. Radical prostatectomy was also associated with fewer urinary irritative symptoms than active surveillance.

All of these effects occurred within the five-year study. However, Barocas and colleagues did not find any differences in general health-related quality of life or disease-specific survival within the short study period.

“It’s possible there are other differences, perhaps related to quality of life, that may take longer to develop,” Barocas said. In particular, survival rate differences between therapies necessitate long-term follow-up, as prostate cancer has a 15-year survival rate as high as 96 percent.

Following Study Participants

Barocas received funding from the National Cancer Institute to expand the CEASAR study and investigate patient outcomes 10-years post-diagnosis. He will apply the same 26-item Expanded Prostate Cancer Index Composite survey used throughout CEASAR, with a few additions.

“We are going compare the available treatments with respect to how many of them are still alive, how many have had cancer recurrence, and how this disease and its treatment have affected their quality of life and finances,” he said.

Together with colleagues from the Vanderbilt Department of Urology, Barocas will follow-up with as many of the initial study participants as possible. The CEASAR expansion will include one of the longest follow-up periods with prostate cancer survivors to date. The results could identify key differences between treatment options undetectable in the initial 5-year study.

Informing Patient Decision-Making

The main goal of the expansion is to equip men newly diagnosed with prostate cancer with comprehensive information about treatment risks and benefits.

“We owe it to them to have more information than just what happens a couple years after treatment.”

“If a patient is going to live for another 20 years, we owe it to them to have more information than just what happens a couple years after treatment. The CEASAR study is a launching pad to get long-term data so patients can make informed treatment choices,” Barocas said.