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Impact of common treatments for early stage disease on quality of life

Posted Sep 29 2008 5:55pm

Knowing how best to treat early-stage prostate cancer is still a problem for doctors and for their patients. Early-stage disease isn’t usually fatal, and aggressive therapy can have serious side effects.

A study in today’s issue of the New England Journal of Medicine is the first to thoroughly examine treatment side effects such as urinary obstruction and vitality in a large, multi-center patient base, to talk about the side effects of prostate cancer therapy, and to examine how an understanding these side effects can help men select treatment.

The study looked at the quality of life of 1,201 men treated at several major clinical centers and 625 of their spouses or partners, after the men received treatment. Physicians and participants “made their own decisions about what treatments to take and weren’t assigned to different groups by the study, so the study’s conclusions are more suggestive than definitive.” This study may be helpful in offering doctors and patients a better appreciation of what to expect from different prostate cancer treatment options. 

Radical prostatectomy was carried out on 561 patients using nerve-sparing procedures. An additional 41 patients had a radical prostatectomy without nerve sparing. A total of 271 patients were treated with brachytherapy, of whom 35 also received radiotherapy, hormone therapy, or both.  About 200 patients received external-beam radiotherapy (EBRT) as their only foirm of therapy. Finally, 90 patients received EBRT combined with androgen-suppression (hormone) therapy.

We can summarize the results as follows:

  • Between 9 and 18 percent of men “reported being distressed” by the effects of adjuvant hormonal therapy.
  • The addition of hormone therapy to treatment with either brachytherapy or external beam radiation therapy had a negative effect on several quality-of-life measures.
  • Men who received brachytherapy had long-lasting urinary irritation, bowel problems, and sexual problems, along with short-term problems with general vitality and hormonal function.
  • Men receiving nerve-sparing surgery had fewer effects on sexual function, but urinary incontinence was relatively common post-surgery.
  • Also in men receiving radical prostatectomy there was a significant improvement in pre-surgical symptoms of urinary irritation and obstruction.
  • Treatment-related symptoms were worsened by obesity, large prostate size, a high pre-surgical PSA level, and older age.
  • Black patients reported a lower degree of overall satisfaction with the outcome of their treatment.
  • There were no treatment-related deaths, and the occurrence of serious side effects was apparently rare.

It should be added that the researchers were surprised to find that depression and lack of energy were the two major symptoms reported by men who received adjuvant hormone therapy in gauging quality of life, whereas few of these men reported hot flashes or breast tenderness. The senior author, Dr. Martin Sanda, is reported as saying that depression and loss of energy “were at least as common as urinary incontinence or bowel problems.”

This study appears to confirm the experiences reported by many patients and previoulsy demonstrated in smaller, single-center studies. Every form of prostate cancer therapy comes with risks for complications and adverse reactions. When you add hormone therapy to any form of radiation therapy, the patient’s quality of life is immediately places at somewhat higher risk. However, it should also be noted that it was only 9-18 percent of patinbets who reported that adjuvant hormone therapy was a significant problem. That means that at least 82 percent of these patients were able to deal with this relatively easily.

Filed under: Living with Prostate Cancer, Management

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