Researchers from several U.S. medical institutions have reported quality of life and satisfaction with treatment among prostate cancer survivors. The details of this study were published in the March 20, 2008 issue of the New England Journal of Medicine.¹

Localized prostate cancer can be treated with equivalent results with surgery, external beam radiation therapy, brachytherapy, or combinations of these treatment modalities. There have been no randomized trials comparing the relative efficacy of these treatments, and no such studies are planned. Patients with localized prostate cancer must choose one of the three options based on observational comparisons of outcomes, which makes the choice difficult. In addition, all forms of therapy are evolving. Robotic surgery is replacing conventional surgery, intensity modulated radiation therapy (IMRT) is replacing conventional external beam radiation therapy, and there are methods to improve delivery of radiation such as the Calypso® system (see related news). There are also several different methods of delivering Brachytherapy, which are often combined with external beam radiation therapy. Nevertheless, it is important to compare the side effects of these different treatments in order to assist patients in making an informed decision. 

The current study looked at quality of life and patient satisfaction in 1,201 patients treated for localized prostate cancer. This study also included 625 spouses or partners of patients treated for prostate cancer. 272 patients received Brachytherapy, and 35 of these also received external beam radiotherapy (EBRT), androgen suppression, or both. 202 patients received EBRT delivered by conformal techniques or intensity modulated radiation therapy (IMRT). Ninety patients received EBRT and androgen suppression. Five-hundred-sixty-one patients underwent prostatectomy with nerve-sparing techniques, and 41 underwent surgery without nerve-sparing techniques. These authors made the following observations:

• Quality of life was adversely affected by androgen suppression in patients receiving EBRT or brachytherapy.
• Brachytherapy was associated with long-lasting urinary and bowel problems and sexual symptoms.
• Nerve-sparing techniques appeared to decrease sexual problems.
• Incontinence was associated with prostatectomy but improved obstructive symptoms.
• There were no treatment-related deaths associated with any treatment.
• Symptoms were increased by obesity, larger prostate size, high PSA, and older age.
• African-American patients reported more dissatisfaction with treatment than White patients.

Comments: These data help to define the unique complications associated with the three main treatment modalities for localized prostate cancer. Continued studies of this nature may assist patients in making more informed choices of therapy.

Related News:

Quality of Life after Different Treatment for Localized Prostate Cancer Evaluated (5/18/2007)

Quality of Life: Brachytherapy vs. Surgery for Localized Prostate Cancer (2/27/2007)

Surgery vs Radiation for Prostate Cancer with Follow-up Until Death: Survival Better after Surgery (7/26/2004)

Reference:

¹ Sanda MG, Dunn RL, Mishaiski J, et al. Quality of life and satisfaction with outcome among prostate cancer survivors. New England Journal of Medicine. 2008;358:1250-1261.