New research shows that prostate cancer therapy could help
men make better choices about the way they want to fight the disease.
There are several treatment options for men with prostate cancer.
There is surgery to remove the prostate, radiation and hormone treatment. These
therapies can have a very different impact on aspects of everyday living, and
these outcomes need to be discussed with the doctor, the patient and his spouse
or partner, the study concludes.
“Every patient has to weigh their hope, fears, concerns and
expectations against the risks and benefits and include their spouse in the
decision-making. You can't expect one size to fit all. Patients are often faced
with decisions based on quality-of-life impact,” said Dr. Jeff Michalski, co
–author of the paper and a radiation oncology professor at Washington
University School of Medicine in St.
Louis.
“With cancer treatment, it's not enough just to be a survivor, particularly
with prostate cancer. The majority of patients are asymptomatic [after
treatment], so their quality of life becomes very important. A paper like this
is important to show some of those effects in a quantified way,” added Dr.
David Chen, attending surgeon with Fox
Chase Cancer
Center in Philadelphia, who was not involved with the
study
The study, involving nine hospitals, looked at
quality-of-life data on 1,201 patients and 625 spouses or partners before and
after radical prostatectomy, brachytherapy (which involved the implant of
radioactive pellets, often called “seeds”in the prostate to kill cancer cells)
or external beam radiation.
One year after treatment, sexual functioning was a moderate
or big problem among 50 percent of men whose prostate had been removed, the
study found. It was a problem for 31 percent treated with external radiation
and 30 percent who had radioactive seeds placed in the prostate. Also, the
study found that surgery to spare the nerves helped prevent sexual problems.
“Overall, 10 to 19 percent of patients or their partners
reported being distressed by symptoms attributable to hormonal therapy,” the
researchers wrote, adding that the finding raises questions about whether
hormone therapy should be restricted to high-risk cases.
The researchers also found that therapy designed to block
the male hormone testosterone for six months had effects on sexuality and
vitality that persisted for up to two years.
Urinary incontinence was a moderate or big problem in 8
percent of surgery patients, 5 percent of seed patients and 4 percent of
radiotherapy patients.
“We hope this information gives patients some realistic
expectations. I don't think our findings are going to make any one of the
specific approaches a winner. But they do make it possible for doctors and
patients to better gauge what to expect for treatment A or treatment B,” says
Martin Sanda, director of the Prostate
Care Center
at Boston's Beth Israel
Deaconess Medical
Center and lead author of
the study.
The findings of the study were published in the March 20
issue of the New England Journal of Medicine.