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.