The three major treatment options for prostate cancer each affect quality of life after treatment in different ways, according to a new multi-center study published last week in the New England Journal of Medicine.
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 forms of treatment on many facets of quality of life, including sexual function, bowel function and urinary incontinence. 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 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,” says senior study author Dr. John Wei, associate professor of urology at the 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 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.
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.
Additional U-M co-authors include Rodney Dunn, statistician expect, Department of Urology; Dr. Howard Sandler, professor of radiation oncology, Medical School; Laurel Northouse, professor of nursing, School of Nursing; Dr. David Wood, professor of urology, Medical School; and Nikhil Shah, former research fellow.
