Life Quality After Prostate Cancer
Neglected Side Effects Predict Satisfaction With Prostate Cancer Treatment
March 19, 2008 -- Side effects men rarely think about before prostate
cancer treatment have huge effects on their after-treatment quality of
The finding comes from a study of 1,201 men -- and 625 of their spouses
or life partners -- before and after they received different treatments for prostate cancer at nine different
high-quality hospitals. All the treatments were successful in that none of the
men died from prostate cancer or from the treatment.
But not all of the men, or their life partners, were happy with the side
effects they experienced after treatment. Some were disturbed by impotence or
urinary/bowel incontinence, the symptoms on
which pretreatment doctor-patient discussions tend to focus.
More neglected symptoms -- related to urinary obstruction or to
"vitality" -- were equally disturbing, found Martin G. Sanda, MD,
director of the Prostate Care Center at Beth Israel Deaconess Medical Center,
"The nice part of the prostate cancer story is that, by and large, the
vast majority of patients are cured. Now the emphasis is on quality of
survival," Sanda tells WebMD. "So we did a catchall study to see if
there are things we can find out to make patients and doctors more accurately
predict what the patient's outcomes will be, and to empower patients to make
decisions based on what is right for them."
The study focused on the side effects men experience in the 24 months after
various prostate cancer treatments:
- Radical prostatectomy, surgery to remove the prostate, using or not using
- External-beam radiotherapy, using newer techniques, either with or without
- Brachytherapy, implantation of radioactive seeds, either with or without
Prostate Cancer Treatment Risks Differ
Every one of these prostate cancer treatments is linked to serious side
effects. Each one has a
different side-effect profile.
When discussing which treatment would be best for an individual patient,
Sanda says doctors and patients tend to focus on three main side effects:
sexual dysfunction, rectal incontinence, and urinary incontinence.
Those side effects have a huge impact on the lives of patients and their
partners. But Sanda and colleagues find that other side effects have just as
much impact. These fall into two main groups:
- Symptoms related to urinary irritation or obstruction, such as pain during urination, weak
stream, and increased urination frequency.
- "Vitality" issues, including energy level, mood, perception of fitness, and weight.
"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
Also new is the concept of "vitality" after prostate cancer
"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."