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Life After Prostate Cancer Treatment

Different Decisions Mean Different Dysfunctions

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 control."

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 treatment.

"At the 24-month time point, they are right up there with the brachytherapy and external-beam radiation patients," Litwin says.

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