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Quality of Life an Issue in Prostate Cancer Treatment

Each therapy has an impact on overall day-to-day living, experts say

WEDNESDAY, March 19, 2008 (HealthDay News) -- Quality-of-life issues should be weighed carefully when prostate cancer patients are considering the thicket of treatment options available to them, new research suggests.

Different 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, concludes a study appearing in the March 20 issue of the New England Journal of Medicine.

"Every patient has to weigh their hope, fears, concerns and expectations against the risks and benefits and include their spouse in the decision-making," said Dr. Jeff Michalski, co-author of the paper and a radiation oncology professor at Washington University School of Medicine in St. Louis. "You can't expect one size to fit all. Patients are often faced with decisions based on quality-of-life impact."

"With cancer treatment, it's not enough just to be a survivor, particularly with prostate cancer," added Dr. David Chen, attending surgeon with Fox Chase Cancer Center in Philadelphia, who was not involved with the study. "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."

Prostate cancer can be successfully treated in a number of ways, notably with a radical prostatectomy, which is surgery to remove the prostate and some surrounding tissue, or with external-beam radiation therapy, or with brachytherapy, in which radioactive "seeds" are implanted in the tumor.

"There are no randomized trials between the three modalities," Michalski noted. "No one is better than the others."

The researchers, from nine hospitals, looked at quality-of-life data on 1,201 patients and 625 spouses or partners before and after radical prostatectomy, brachytherapy or external-beam radiation.

One major finding: adding hormone therapy to brachytherapy or radiation therapy worsened various quality-of-life measures.

Other findings were less clear-cut:

  • 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.
  • Nerve-sparing prostatectomies had fewer effects on sexual function. But urinary incontinence was often seen after the surgery.
  • Treatment-related problems tended to be worse in patients who were older, obese, had large prostates or a high prostate-specific antigen (PSA) score.

Overall, black men reported lower satisfaction with overall outcomes, including those related to quality of life.

Spouses and partners were directly affected by the quality-of-life changes, the research showed, with their emotional state linked to the patient's own level of satisfaction with the treatment outcome.

"This will help people tailor discussion and decision-making," said study senior author Dr. John Wei, associate chair for clinical research at the University of Michigan Medical School in Ann Arbor. "We know more than is typically used in practice."

More information

There's more on prostate cancer therapies at the U.S. National Cancer Institute.

SOURCES: David Chen, M.D., attending surgeon, Fox Chase Cancer Center, Philadelphia; John Wei, M.D., associate chair for clinical research and associate professor of urology, University of Michigan Medical School, Ann Arbor; Jeff Michalski, M.D., professor of radiation oncology, Washington University School of Medicine, St. Louis; March 20 New England Journal of Medicine
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