Life Quality After Prostate Cancer
Neglected Side Effects Predict Satisfaction With Prostate Cancer Treatment
Prostate Cancer Treatment Risks Differ continued...
Hormonal therapy generally made the side effects of radiation therapy and
brachytherapy worse. Nerve-sparing surgery generally lessened the side effects
Patients had worse side effects if, at the time of treatment, they were obese, had a large prostate,
had high PSA scores, or were older.
African-American patients reported significantly less satisfaction with
their prostate cancer treatment choice than did white patients. Because all
patients in the study received the same quality of treatment, Sanda has two
theories about this finding.
"Perhaps African-American patients weren't counseled as effectively
about what they could expect after treatment," he says. "Or it may be
the recognized reality that African-Americans tend to have somewhat worse
prostate cancer than patients of other races."
Durado Brooks, MD, MPH, director for prostate and colorectal cancers at the
American Cancer Society, agrees that the study raises questions about
African-American men's expectations from prostate cancer treatment.
"Beyond communication issues is the question of whether African-American
men have a different level of expectations based not on education but on
culture," Brooks suggests.
Prostate Cancer Treatment: Don't Make Tough Decision Alone
Brooks says the Sanda study will be very helpful to patients -- as far as it
goes. He notes that the two-year study overestimates the lifelong bother of
side effects that may get better after two years, and underestimates the bother
of side effects that take longer to appear.
"For example, after external-beam radiation, sexual dysfunction may take
up to four years to appear," Brooks tells WebMD. "So it is very
positive that, two years after external-beam radiation, men in the Sanda study
maintained a high level of sexual function. But until we have four or five
years of data, we won't know what the long-term outcomes will be."
He praises Sanda and colleagues for shedding light on the issue of including
spouses or life partners in prostate cancer treatment decisions.
"Prostate cancer is very much a disease that impacts the entire family
unit," Brooks says. "Men who in isolation make decisions according to
what they think their spouse wants often turn out to be 180 degrees off from
what their spouse really wants. Men and their spouses are going to live the
rest of their lives with the consequences of this decision. It is best when
both learn everything they can before making that decision."
Sanda notes that the first thing patients and their partners should focus on
is which treatment is most likely to cure the cancer. After that, the question
becomes which treatment has least impact on the life-quality factors that
matter most to the patient and his partner.
"Our study suggests that the things to bring up are not just the issues
of urinary incontinence and impotence and rectal side effects, but urinary
obstruction, whether the patient has symptoms already, and the issue of
vitality," Sanda says. "If hormonal treatment is part of the picture,
ask about the side effects. We have long recognized that there can be breast
tenderness and hot flashes, but we found these
symptoms were relatively inconsequential compared to loss of energy and mood