Type of Prostate Cancer Treatment Affects Quality of
Life: Factor to Consider
Prostate size, other neglected factors influence
satisfaction with treatment outcomes
March
20, 2008 – The wide spread prevalence of prostate cancer, and the fact
that it often strikes men so late in life, feeds an on-going debate
about the best way to treat it. A major new study, however, says that of
the three major treatment options, there is a distinct difference in how
each affected the quality of life after treatment.
Outcomes after prostate surgery, external radiation
or
brachytherapy (radioactive seeds) are highly individualized and
depend not only on age, but also on factors that have been previously
overlooked, such as the size of the prostate and whether a man has
urinary symptoms due to prostate enlargement before treatment.
The study examined the impact of the various forms
of treatment on many facets of quality of life, including only sexual
function, bowel function and urinary incontinence. But the researchers
also looked at concerns that are common yet had not been previously
studied, including weak or frequent urination due to prostate
enlargement as well as a man’s “vitality” or hormonal function.
Researchers from nine hospitals, including the
University of Michigan Comprehensive Cancer Center, evaluated
health-related quality of life and satisfaction for 1,201 men treated
for localized prostate cancer with either brachytherapy, external
radiation therapy or surgery, with and without the addition of therapy
designed to suppress certain hormones. The study also included 625
spouses or partners.
Age is the most important risk factor for prostate cancer. More
than 65% of cases are diagnosed in men over age 65 - average age
at the time of diagnosis is 70. –
NIH SeniorHealth
"We found that each prostate cancer treatment was
associated with a distinct pattern of change in health-related quality
of life, which then influenced satisfaction of both patients and their
spouses or partners,” says senior study author
John T. Wei, M.D., associate professor of urology at the
U-M Medical School.
“Given these findings, I would recommend that both
men and their spouses or partners familiarize themselves with how each
of these different treatments is expected to affect their urinary and
sexual function. By doing so, they may be able to better prepare for the
consequences and complications related to treatment,"
Researchers found that hormonal therapy, when
combined with brachytherapy or with external radiation, worsened
multiple aspects of quality-of-life, and had particularly profound
effects on men’s vitality and sexuality. Patients receiving radioactive
seed treatment experienced problems with weak or frequent urination,
which lasted longer and had greater effect on overall satisfaction than
previously appreciated.
Some men who had their prostates removed surgically
reported problems with urinary incontinence, in contrast to those who
experienced long-term improvement in urinary obstruction. Nerve-sparing
techniques reduced the sexual side effects of that surgical procedure
but did not eliminate them.
The study was the first multi-center effort to
focus on satisfaction with overall outcome of cancer care and to include
partners in the evaluation. And the results found that changes in
quality of life played a significant role in determining whether
patients and their partners were satisfied.
“We didn’t presume whether one type of side effect
or another is more important – instead, we measured a broad range of
side effects, and asked how those mesh together and which ones actually
matter in terms of either the patient’s or his partner’s satisfaction
with the overall cancer treatment outcome,” says lead study author
Martin G. Sanda, M.D., director of the Prostate Care Center at
Beth Israel Deaconess Medical Center and associate professor of
surgery at
Harvard Medical School.
The research found a greater level of importance
than previously thought in a patient’s vitality, which includes concerns
expressed by patients and their partners about the patient’s energy
level, weight and mood.
“When the patient and doctor sit down, they need to
be able to take factors like the patient’s age, prostate size, and
treatment nuances into consideration and decide what’s right. The
concept of assigning a general treatment or non-treatment based simply
on someone’s age and cancer severity alone is no longer valid,” Sanda
says.
Editor’s Notes:
The study’s co-authors were: Rodney L. Dunn,
M.S., Howard M. Sandler, M.D., Laurel Northouse, Ph.D., R.N., David
Wood, M.D., and Nikhil Shah, D.O., University of Michigan; Irving
Kaplan, M.D., Beth Israel Deaconess Medical Center; Xihong Lin, Ph.D.,
Harvard School of Public Health; Larry Hembroff, Ph.D., Michigan State
University; Thomas K. Greenfield, Ph.D., Public Health Institute,
Emeryville, Calif.; Mark S. Litwin, M.D., Ph.D., Christopher S. Saigal,
University of California at Los Angeles; Arul Mahadevan, M.D., Eric
Klein, M.D., and Jay Ciezki, M.D., Cleveland Clinic; Louis L. Pisters,
M.D. and Deborah Kuban, M.D., M.D. Anderson Cancer Center; and Jeff
Michalski, M.D. and Adam Kibel, M.D., Washington University, St. Louis.
For information about prostate cancer treatment,
visit
www.mcancer.org or call the U-M Cancer AnswerLine at 800-865-1125.
Nicole Fawcett was a major contributor to this
report
March
20, 2008 – The wide spread prevalence of prostate cancer, and the fact
that it often strikes men so late in life, feeds an on-going debate
about the best way to treat it. A major new study, however, says that of
the three major treatment options, there is a distinct difference in how
each affected the quality of life after treatment.