Life After Prostate Cancer Treatment
Different Decisions Mean Different Dysfunctions
WebMD News Archive
Prostate Treatments: Radiation and Surgery continued...
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?'"
Side Effects: Dysfunction, Other Annoyances
Perhaps because it's a newer treatment, brachytherapy burst onto the scene
only a few years ago as the newest, greatest thing for prostate cancer. There's
no doubt it's effective. But Litwin says that neither brachytherapy nor new
external-beam radiation techniques avoid serious side effects.
"Brachytherapy and external-beam radiation have a much more profound and
persistent effect on the bowel than patients realize," he says. "And
brachytherapy tends to have more of an effect on patients' urinary voiding.
Surgery, on the other hand, has a much greater effect on erections and urinary
Simply listing cancer treatment side effects doesn't give a full picture of
a patient's quality of life. Litwin and colleagues also evaluated how much
these symptoms actually bothered the men.
"After surgery, patients who have mild incontinence are somewhat
bothered, but nowhere near as bothered as those with the severe urinary
blockage problems sometimes caused by radiation treatments," he says.
"On the other hand, even though we talk about bowel dysfunction being an
issue for brachytherapy and external-beam radiation patients, at most only 20%
of these patients experience severe bother from bowel symptoms."
Sexual dysfunction, however, severely bothered men in all of the treatment
groups. Sixty percent of the surgery patients reported severe bother from
sexual dysfunction -- but that tended to diminish over time.
Among men who had no sexual dysfunction before surgery and who underwent
nerve-sparing surgery, sexual function improved over the first two years after
"At the 24-month time point, they are right up there with the
brachytherapy and external-beam radiation patients," Litwin says.