there is no free ride-pick your poison

Quality of Life of Prostate Cancer Patients Differs by Treatment Choice

Researchers from Australia have reported that various treatments for prostate cancer have “persistent effects on quality of life.” The details of this population-based cohort study were published in the January 23, 2010 issue of the British Journal of Medicine.[1]

The impact of prostate cancer on quality-of-life issues has been evaluated in various studies of specific therapies. However, there have been few population reports on the overall impact of prostate cancer on quality of life.

The current study included 1,642 men with localized prostate cancer below the age of 70 years and 495 similar control patients without prostate cancer. The majority of patients were treated with radical prostatectomy (60%) and the remainder with watchful waiting, androgen deprivation therapy (ADT), and external beam radiation therapy (EBRT) with or without ADT or brachytherapy given in high or low dosage. These authors made the following observations:

• Physical health appeared to be the worst for men who received ADT alone or with EBRT.
• Mental health did not appear to differ between groups and was not different from controls.
• Urinary problems were higher in prostate cancer patients than controls at baseline and worsened in most treatment groups.
• Radical prostatectomy was associated with the highest rate of incontinence: 12% at three years.
• Sexual dysfunction was more frequent for all treatment groups than among controls, especially in men receiving ADT.
• Bowel dysfunction was the worst in men receiving EBRT.

Comments: These authors suggest, “Men with prostate cancer and the clinicians who treat them should be aware of the effects of treatment on quality of life, and weigh them up against the patient’s age and the risk of progression of prostate cancer if untreated to make informed decisions about treatment.”

My thoughts-

When I began my career in 1986 the debate about whether to pursue radiation or surgery for prostate cancer centered almost exclusively on cure concerns. As time evolved there was a waxing and waning about which mode of therapy best balanced quality of life issues vs. cure concerns. This study makes some observations that the average prostate cancer patient trying to decide what to do fail to factor into their decision. Note that sexual function and voiding issues are affected by all treatments. A  prostatectomy can be associated with stress incontinence and external beam radiation can cause  bowel issues.

Pick your poison, there is no free ride. The comment at the end is well spoken.          The Decision: Your prostate biopsy is positive. Now what?   nicely delineates the issues as they pertain to the  treatment options, particularly voiding and erectile side effects.