Life After Prostate Cancer Treatment
Different Decisions Mean Different Dysfunctions
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.
Bottom Line: "Doc, How Well Will I Do?"
Of course, patients don't really want to know the percentage of men who get
this or that symptom. What each man really wants to know is how well he will do
"We talk about sexual, urinary, and bowel function, but the main point
is that the overall physical and mental recovery from any one of these three
prostate cancer treatments is equivalent," Litwin says. "Patients get
back to where they started and stay there -- pretty fast. So at least in terms
of overall physical and mental well-being, they can expect a fairly rapid
This may be a bit overoptimistic, suggests Steven Zeliadt, MD, PhD, a
research scientist at Seattle's Fred Hutchinson Cancer Research Center who has
studied prostate cancer treatment outcomes.
"These men really are regaining function," Zeliadt tells WebMD.
"But still, a considerable number of people do not regain function two
years later. That is particularly true for urinary and sexual function. And
this is something men are not picking up on in their decision making."
Zeliadt praises the Litwin study for focusing on something men usually don't
think about until it's too late.