When faced with a prostate cancer diagnosis, patients can opt between three different treatment courses, depending on how advanced their cancer is and the rhythm of tumor progression.
These standard treatment plans comprise radical prostatectomy (surgical intervention to remove the prostate gland), radiation therapy or brachytherapy (the insertion of radioactive seeds within the tumor to destroy cancer cells), and active surveillance (monitoring the cancer's progression).
Surviving this terrible condition is undoubtedly everyone's first priority, but there's much to be said about the quality of life following treatment procedures, as all three cancer therapy options provide different outcomes in this respect.
To help patients weigh all the possible consequences, researchers investigated how each option affects the sexual, urinary, and bowel functions two to three years after treatment, and published their conclusions in two separate studies, both featured on March 21 in the Journal of the American Medical Association.
"Patients diagnosed with early-stage prostate cancer - and that's the vast majority of patients with this disease - face many treatment options that are thought to be similarly efficacious," said Dr. Ronald Chen, one of the study authors.
"Therefore, the quality-of-life differences among these options become an important consideration when patients are trying to make their decisions," he added.
Short-Term Side Effects
In his study, Chen and his team from the University of North Carolina analyzed patient outcomes for each procedure spanning from three months to 12 months and 24 months after treatment. Researchers examined patient data from 1,141 men with an average age of 66 years, who had been diagnosed with prostate cancer between 2011 and 2012.
Of all the study participants, 469 men had undergone radical prostatectomy, 246 patients had opted for external beam radiotherapy, 109 had chosen brachytherapy, while the remaining 314 had put their faith in active surveillance.
The Prostate Cancer Symptom Indices enabled scientists to evaluate four separate criteria describing quality of life outcomes: sexual dysfunction scores, the incidence of urinary obstruction and irritation, the occurrence of urinary incontinence, and bowel dysfunction rates.
Study results revealed that, three months after treatment, sexual function was better retained in active surveillance patients, as opposed to the other three groups. In addition, men who underwent radiotherapy and brachytherapy also reported urinary obstruction and irritation.
Meanwhile, radical prostatectomy was found to cause more cases of urinary incontinence three months after surgery, whereas external beam radiotherapy was linked with acute urinary problems and bowel symptoms.
Comparative analysis two years after treatment showed deterioration in sexual function for 57.1 percent of men who had surgery, 27.2 percent of subjects who were exposed to external beam radiotherapy, 34.2 percent of brachytherapy patients, and 25.2 percent of study participants who chose to monitor their tumor progression.
"There has not been a large-scale comparison of the quality-of-life impact for these modern options, until now," said Chen, who believes patients can benefit from this updated data on treatment outcomes, which serves to help them "make informed decisions about the choices they face."
Patient Outcomes 3 Years After Treatment
In another paper, Dr. Daniel Barocas from the Vanderbilt University Medical Center investigated the same three functions along with hormonal function. The study involved 2,550 men with an average age of 63.8 years who had been treated for localized prostate cancer.
Following diagnosis in 2011 and 2012, 1,523 patients were treated with radical prostatectomy, 598 men underwent external beam radiation therapy, and 429 study participants chose active surveillance.
Data from five Surveillance, Epidemiology, and End Results or SEER registries, as well as the Cancer of the Prostate Strategic Urologic Research Endeavor, allowed Barocas to examine patient outcomes three years after treatment.
His team observed that radical prostatectomy is linked to sexual dysfunctions in the long term, which was not the case for the other two treatment options.
Surgery was also associated with worse urinary incontinence compared with radiation therapy and progression monitoring, but proved to cause fewer symptoms for urinary irritation than active surveillance.
In terms of bowel or hormone function, the study didn't reveal any significant long-term differences between the three treatment plans.
"These findings may facilitate counseling regarding the comparative harms of contemporary treatments for prostate cancer," noted Barocas' team.
