Life Quality After Prostate Cancer
Neglected Side Effects Predict Satisfaction With Prostate Cancer Treatment
Prostate Cancer Treatment Risks Differ continued...
"One thing that is new here is the entire notion that symptoms related to urinary obstruction are an important component of quality of life in these patients," Sanda says. "It is something that should be brought up to the same degree as issues of impotence or rectal incontinence problems."
Also new is the concept of "vitality" after prostate cancer treatment.
"Vitality is not a concrete physical symptom or something you can directly measure," Sanda says. "But the things in this area that patients reported being affected by treatment are things like energy level, mood, and perception of fitness, or weight. For some patients, especially those treated with hormone-suppressing therapy, this was at least as troublesome to them as impotence and bowel problems."
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.