New research: Better Sexual Function After Radiation Compared to Surgery in Prostate Cancer

Prostate cancer is primarily treated with surgery or radiation. Both methods are equally effective in curing the cancer, but the extent of potential side effects varies. A long-term study on patients with localized prostate cancer now clearly shows that sexual function deteriorates significantly more—and for more patients—following surgery. Urinary incontinence issues were also much more common in this group. Two factors with possible substantial impact on patients' long-term quality of life.

Men with localized prostate cancer are often faced with the choice of treating the disease with surgery or radiation. The study Radical Prostatectomy Versus Stereotactic Radiotherapy for Clinically Localised Prostate Cancer: Results of the PACE-A Randomised Trial, published in European Urology in September this year, examined patients’ perceived quality of life after treatment. The study focused on occurring side effects such as urinary incontinence, sexual function, and bowel issues.

123 men with localized prostate cancer treated at eight different clinics in the UK were randomly assigned to two groups: one received SBRT* with five radiation treatment sessions, and the other underwent surgery. Conducted between 2012 and 2022, the study followed patients for an average of over five years.

Results: Better with Radiation
The study results show that radiation therapy leads to significantly fewer side effects in terms of sexual function and urinary incontinence compared to surgery. Radiation was associated with slightly higher rates of bowel problems, albeit in mild forms. Two years after treatment, 50% of surgical patients used incontinence pads, compared to just 6.5% of those treated with radiation. The perceived problems regarding sexual function, measured using the EPIC method** where 100 represents optimal function, scored 62.5 for radiation-treated patients. The corresponding figure for patients treated with surgery was 18, i.e. significantly poorer function.

According to the researchers, the study is a step towards being able to provide patients with better guidance and enabling them to make informed treatment decisions based on facts that include long-term side effects.

Even Better with Today’s Technology
Since the treatments in the study were carried out, radiation therapy technology has evolved significantly. It is now possible to control the radiation’s target area with millimetre precision in real time. This precision is crucial because the prostate, like other organs, often moves unpredictably.  During ongoing treatment, the prostate’s movement can reach up to 1.5 centimetres, which entails a high risk that the radiation dose will end up outside the planned radiation area. This impairs the effect of radiation on the cancer and may harm adjacent organs and healthy tissue, potentially causing side effects with negative impact on patient's quality of life.

“It is highly reasonable to assume that if the study had been conducted using the technology available today, the radiation-treated patients would have experienced even fewer side effects,” says Thomas Lindström, Managing Director of Micropos Medical, a Swedish medical device company.

Micropos Medical has developed the Raypilot® System, a medical device that provides real-time tracking of the prostate’s position, in relation to the radiation field, during radiation therapy. This enables healthcare providers to deliver radiation with high precision, significantly reducing the risk of side effects.

Life After Treatment
“It’s high time to start focusing on the quality of life for prostate cancer patients after treatment. Both radiation and surgery are effective in curing early-stage prostate cancer. But the differences in terms of side effects are significant and must be taken seriously. That is why this study is so essential. The results are highly relevant for healthcare providers and patient organizations, and it’s important that this knowledge also reaches patients,” says Thomas Lindström.

*SBRT, Stereotactic Body Radiation Therapy, is a treatment method where patients receive radiation therapy in five or fewer sessions, over five or fewer consecutive days, with significantly higher radiation doses each time compared to traditional treatment requiring 20-40 treatment sessions. SBRT uses sophisticated real-time monitoring with 3D imaging that enables precise radiation targeting while avoiding healthy tissue.

** EPIC, Expanded Prostate Cancer Index Composite, is a scientific instrument designed to evaluate patient function and bother after prostate cancer treatment.

Prostate cancer is the second most common cancer in men globally. The number of detected cases has increased significantly in recent decades; from 1.1 million registered cases in 2012 to 1.4 million cases in 2020. The disease is most common in the Western world, where PSA tests are frequently used. In Europe, approximately 470,000 men are diagnosed with prostate cancer every year.

For further information, contact:

Thomas Lindström
Managing Director, Micropos Medical
thomas.lindstrom@micropos.se
+46 76 140 72 29

Micropos Medical AB is a Swedish medical device company that develops, manufactures, and sells technology enabling enhanced radiotherapy cancer treatment. The Raypilot® System, the product from the company, generates high precision as well as high efficiency through real-time tumour tracking in radiation treatment of prostate cancer. Using The Raypilot System, clinics can treat their patients with accuracy and reduced risk of damaging healthy tissue surrounding the tumour. The company is listed on the Spotlight Stock Market. www.micropos.se

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