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Life After Prostate Cancer Treatment

Different Decisions Mean Different Dysfunctions
By
WebMD Health News
Reviewed by Louise Chang, MD

April 25, 2007 -- Which side effects of prostate cancer treatment would bother you least? A new study points out the risks for each treatment option.

Here's one option you don't have: No current treatment for prostate cancer completely avoids the risk of serious side effects.

But there's also good news in the study from Mark Litwin, MD, MPH, and colleagues: During the first two years after treatment, the side effects tend to diminish or become less bothersome. So far, it seems this trend will continue over the study's next three years.

"It is not just survival that matters after treatment for prostate cancer -- quality of life matters, too," Litwin tells WebMD. "Not one of these treatments is better or worse over time. Each has its own unique impact on quality of life."

Those impacts differ between treatments.

"The main problem with brachytherapy is urinary irritation and some bowl irritation. The main problem for external-beam radiation is urinary irritation and, to a lesser extent, bowel irritation. And the main problem for surgery is sexual function -- the ability to get an erection -- and, to a lesser extent, urinary incontinence," Litwin says.

Litwin, professor of urology and public health at UCLA and a researcher at UCLA's Jonsson Cancer Center, and colleagues report their findings in the June 1 issue of the journal Cancer.

Prostate Treatments: Radiation and Surgery

There are three major treatments for prostate cancer:

  • Radical prostatectomy or surgical removal of the prostate. This is usually performed by urologists. When possible, doctors perform a nerve-sparing procedure that reduces the side effect of sexual dysfunction.
  • External-beam radiation. This is performed by a radiation oncologist and is designed to maximize radiation to the prostate and to minimize radiation to the bladder and rectum.
  • Brachytherapy. A radiation oncologist implants some 100 tiny radioactive "seeds" into the prostate. This sometimes is done in combination with external-beam radiation or radiation applied via removable catheters.

Each technique is highly successful at curing early prostate cancer. Prostate cancer treatments continue to evolve, but Litwin says the evidence so far fails to show that any one treatment has a better cure rate than another.

That's not the case for treatment side effects. Previous studies showed that the different treatments have different side effects. But these studies had a serious problem: They didn't measure men's quality of life before they underwent treatment for prostate cancer.

"Men tend to romanticize how good their function used to be if you ask them to remember back," Litwin says. "For example, if you ask a man how good his sexual function was eight years ago, his answer may not give a precise picture of how it actually was."

Men in the Litwin study averaged 60 to 70 years of age. One thing that surprised the researchers was that many of the men had sexual, bowel, and/or urinary dysfunction before prostate cancer treatment.

"The average 65- to 70-year-old man's urinary, bowel, and sexual functions are simply not perfect. One has to be cognizant of that when looking at how a patient does after treatment," Litwin says. "If a 70-year-old patient asks me how good his sexual function will be after surgery, it's like the old story where the patient asks, 'Doc, will I be able to play Rachmaninoff after surgery?' I have to ask, 'Well, could you play it before?'"

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