Prostate Cancer Therapy Mismatch?

Nov. 26, 2007 -- Researchers are urging men with early prostate cancer to talk with their doctor about any bowel, urinary, or sexual problems before choosing a prostate cancer treatment.

In a new study, more than a third of men with early prostate cancer got "mismatched" prostate cancer treatments.

That is, those men got treatments that tended to aggravate their pre-existing bowel or bladder conditions -- and not to improve sexual function.

"Our observations raise concerns about physician-patient communication," write the researchers, who included Ronald Chen, MD, of Massachusetts General Hospital in Boston.

Early Prostate Cancer Study

Chen's team studied 438 U.S. men who were diagnosed with early prostate cancer between 1994 and 2000.

The patients completed surveys about their bowel, urinary, and sexual symptoms before choosing prostate cancer treatments including:

• Radical prostatectomy: Surgery to remove the prostate
• Brachytherapy: Radiation from implanted radioactive "seeds"
• External beam radiation: Radiation given from outside the body

Nearly all of the men -- 89% -- reported at least one problem in those three areas before treatment. That's a surprisingly high percentage, Chen's team notes.

The researchers made three predictions:

• External beam radiation would tend to aggravate bowel problems
• Brachytherapy would tend to worsen urinary obstruction or irritation
• Patients with erectile dysfunction might not benefit from nerve-sparing radical prostatectomy, surgery to remove the prostate while avoiding nerves in that area.

Those predictions proved correct over the next three years.

But the reasons for those mismatches remain a mystery. It's not clear if the men and their doctors had a frank talk about symptoms before picking a prostate cancer treatment.

That sort of discussion can't hurt and might help avoid those problems, the researchers suggest.