Trouble Ahead, No Matter the Cancer Treatment

Prostate cancer patients face similar declines in bodily function

(RxWiki News) Surgery and radiation therapy are common ways to treat prostate cancer. In the long run, however, men experience the same declines in bodily functions, regardless of the treatment they receive.

When it comes to stopping or slowing localized prostate cancer, prostatectomy (surgical removal of the prostate) or radiotherapy (radiation) can each be effective techniques.

A recent study found that no matter the therapy, patients experienced functional declines. While patients receiving either treatment experienced differences early on, they had no major dissimilarities in bodily functions 15 years after treatment.

"Ask a doctor how prostate treatment may affect quality of life."

Matthew Resnick, MD, in the Department of Urologic Surgery, Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center in Nashville, Tennessee, and his cohorts examined the long-term health status of 1,655 prostate cancer patients.

Patients were between the ages of 55 and 74 and had either undergone surgery (1,164) or radiation therapy (491). Their tumors were localized and had not spread to other parts of the body. Data came from the Prostate Patient Outcomes Study (PPOS).

Investigators evaluated urinary, bowel and sexual function at two, five and 15 years after diagnosis.  

In the early stages, the authors noted differences between the two groups. Patients who had prostatectomy were more likely to have urinary incontinence (loss of bladder control). At two years, 9.6 percent of surgery patients had no control or frequent urinary leakage, compared with 3.2 percent in the radiation group. At five years, it was 13.4 percent versus 4.4 percent. 

Prostatectomy patients also had more erectile dysfunction at two years (78.8 vs. 60.8 percent) and five years (75.7 vs. 71.9 percent). Patients in the radiotherapy group were more likely to have bowel urgency at two years (7.9 vs. 2.9 percent) and five years (5.8 vs. 4.4 percent).

There were no significant differences between the groups at 15 years. Authors remarked that the similar functional declines may largely be due to aging.

At the time of the 15-year survey, 322 of the 1,164 men in the prostatectomy group (27.7 percent) and 247 of the 491 men in the radiotherapy group (50.3 percent) had died.

Dr. Resnick told dailyRx News, “Men who undergo surgery or radiation for localized prostate cancer are equally likely to experience difficulty urinating, impotence or bowel trouble. Fortunately, men with localized prostate cancer have a long-term horizon, but they need to take into account the potential harms and potential functional deficits they are going to have after treatment.”

Dr. Resnick continued, “I wish I could tell you that surgery is the best for everybody or radiation is the best, but our study doesn’t tell us that. It gives us information, and it is an impetus to personalize treatment based on patient preferences and desires.”

As for future research, Dr. Resnick would like to see how emerging technologies, such as robotic surgery, intensity modulated radiation therapy (IMRT) and proton therapy, may affect functional outcomes.

The study was published January 31 in The New England Journal of Medicine. Research was supported by a grant from the National Cancer Institute and National Institutes of Health. Dr. Resnick was supported by the Veterans Affairs National Quality Scholars Program and the T.J. Martell Foundation.

Review Date: 
January 29, 2013