March 19, 2008
Type of prostate cancer treatment affects quality of life, multicenter study finds
Prostate size, other neglected factors influence satisfaction with treatment outcomes
Ann Arbor, MI – Of three major treatment options for prostate cancer, each affected quality of life after treatment in different ways, according to a new multi-center study published Wednesday in the New England Journal of Medicine.
John T. Wei, M.D.
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.
"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. 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," says senior study author John T. Wei, M.D., associate professor of urology at the U-M Medical School.
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.
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.
Written by: Nicole Fawcett
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