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Life Quality After Prostate Cancer

Neglected Side Effects Predict Satisfaction With Prostate Cancer Treatment
By
WebMD Health News
Reviewed by Louise Chang, MD

March 19, 2008 -- Side effects men rarely think about before prostate cancer treatment have huge effects on their after-treatment quality of life.

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, and colleagues.

"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 nerve-sparing techniques.
  • External-beam radiotherapy, using newer techniques, either with or without androgen-suppressing therapy.
  • Brachytherapy, implantation of radioactive seeds, either with or without androgen-suppressing therapy.

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 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."

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