This is a study of about 32,000
men who underwent prostate cancer treatment in Ontario
between 2002 and 2009. And we examined
various complication rates from undergoing surgery or radiation
for the treatment of prostate cancer. And we looked at 5 specific
complications that require treatment [ remedial ]. The first was hospital admission
rates. The second was what we call urologic
procedures, or the need for urologic procedures. Third, was
the need for gastrointestinal procedures. Four was the need for
major open operative procedures. And five, was the rates
of secondary cancers that might develop due to the treatment exposure.
What we found, was that the rates of complications were quite high
for all patients. Up to 30% were reported
for some of these complications. A patient's age, and their level
of co-existing medical illnesses, were strong predictors
for having these types of complications. What we found that was quite striking
however, was that specific type of treatment, radiation
or surgery, was the strongest predictor for
the rates of these complications. This is the first study that
comprehensively describes these types of complications.
This is a reflection of the whole population, and not just a sort of a set of
experiences from single centres. And that's what's quite unique about it. We're giving
real world experiences. We found that patients who underwent surgery
experienced lower rates of needing a hospital admission to treat complications,
lower rates of gastrointestinal procedures, and lower
rates of requiring open surgical procedures. On the other hand,
we found that patients who had radiation,
experienced lower rates of requiring urologic procedures. And that makes biologic sense,
when you think about the impact of radiation and surgery, to
the prostate gland and the surrounding organ. In particular, however, when we looked at
the final and fifth outcome, what was striking was that we found
rates of second cancer to be higher
among patients who underwent radiation, compared to patients
who underwent surgery. And we compared the rates of cancers to the general
population. So we can conclude that these rates of second
cancers were attributed to the primary treatment.
Another uniqueness of the study, was that we collaborated
with our colleagues in radiation oncology. And from the beginning,
we looked at the various list of complications and we wanted to make sure
that we treated each group: the surgery group, and the radiation group -
fairly and equally. That is, all the
different types of complications were included in each group.
We also then, 'blinded' ourselves or masked ourselves from what type of treatment the patient had,
when we assigned the complications that might have occurred during the study period.
So I think those two elements gave this a very non-biased look
at what happens to these types of patients.
The conclusion of the study should NOT be that everybody should go rushing off
to have surgery. Not by an means. What we should conclude from
this study is that the complication rates from both radiation
and surgery are high. And that we need to be aware of these rates of
complications when we have the initial discussion with patients
about how best to treat their prostate cancer. Certainly, there's been
a lot of strong evidence, that we don't need to treat many patients with prostate
cancer, and providing this new data, certianly will
help make the argument that many patients perhaps should not consider
undergoing treatment because they don't need it and they don't need to be subjected
to these unnecessary complications. On the other hand,
it's very intriguing to show that in our study
despite the fact that we did every method to
make sure that there was a fair comparison between the patients who had surgery
and radiation, patients who had surgery experienced less
rates of complications, than those who had radiation. And that's certainly
very provocative.