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Prostate Cancer Treatment: Know the Risks

Treatments for prostate cancer can lead to long-term complications associated with worse quality of life and new health risks, according to a study in JAMA Oncology. The findings revealed a substantially higher risk of complications in men treated for prostate cancer compared with a similar group of men without prostate cancer. At 12 years after treatment, men whose prostates had been removed had a seven times higher risk of urinary or sexual complications, while men who underwent radiotherapy had a three times higher risk of these complications, according to a story in MedPage Today. Men treated with radiotherapy also had a nearly three times greater risk of developing bladder cancer and a higher risk of bladder cancer that required surgery than men who were not treated. In addition, erectile dysfunction, urinary incontinence and placement of a penile prosthesis were more than twice as likely after radiotherapy compared with the untreated population. “Complications after prostate cancer treatment are common and are associated with a myriad of harms; inadequate understanding of these risks may lead to patients regretting their treatment decisions,” wrote researcher and study lead author Joseph M. Unger of the Fred Hutch Cancer Center in Seattle and his colleagues. “Accurate characterization of treatment risks is vital for informed decision-making, especially because complications can occur early after treatment whereas benefits may accrue years later.” The authors highlighted the importance of counseling patients before prostate cancer screening, biopsy and treatment.

Lung Cancer Screening Rates Lag Behind Other Screenings

Less than 20% of Americans who are eligible for lung cancer screening actually get tested, according to a recent study in JAMA Network Open, compared with 70% to 75% of Americans who receive other screenings like mammograms for breast cancer or colonoscopies for colon cancer. More Americans die of lung cancer than any other form of cancer, and nearly half of those with the disease are diagnosed after it has spread outside the lung when survival is low. There are a number of possible reasons for low lung cancer screening rates, wrote radiologist Omer Awan of the University of Maryland School of Medicine in Baltimore, in an article in Forbes. Awan is also a senior contributor to Forbes. Among the reasons for the low rate, many Americans are not aware of the screening test, which consists of a low-dose CT scan of the chest, and eligibility rules are confusing. Guidelines recommend annual screening for people between 50 and 80 years of age who have a 20 pack-year smoking history and smoke currently or have quit in the last 15 years. A pack year is a measure equal to smoking one pack of cigarettes a day for a year, so 20 pack years could be smoking one pack a day for 20 years, two packs a day for 10 years, or any such combination. “This confusion about what the specific screening test is and who is actually eligible could be a significant barrier for the many that really could benefit from the test,” Awan wrote. Another barrier to screening could be that many primary care doctors don’t discuss lung cancer screening with their patients. A study published in Cancer Epidemiology, Biomarkers & Prevention found that less than 10% of physicians regularly discuss the screening with patients. “This underscores the need for physicians to understand lung cancer screening recommendations as well as to counsel patients on its importance,” Awan wrote.

Psoriasis Can Be an Immunotherapy Side Effect

Patients treated for cancer with PD-1 and PD-L1 immune checkpoint inhibitors (ICIs), a type of immunotherapy, are more likely to develop psoriasis than patients treated with chemotherapy or targeted therapies. Findings from a study published in JAMA Dermatology revealed that the risk of psoriasis, a chronic inflammatory skin disease, among patients with stage III or IV cancer was two to three times higher among ICI users compared with patients receiving other treatments. While the overall incidence of psoriasis is low in these patients, the study authors wrote, “it is important for medical professionals, clinicians, and caregivers to be aware of this potential risk to improve skin health and ensure optimal cancer care.” Dermatologist Shoshana Marmon of New York Medical College in Valhalla, New York, who was not involved in the study, told MedPage Today, “Oncologists should monitor for early signs of psoriasis after starting ICIs, educate patients to report skin changes promptly, and collaborate with dermatologists on how to best manage psoriasis without disrupting cancer treatment.”