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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 of prostatectomy.

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 effects."

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