More than 200,000 men will be diagnosed with prostate cancer this year. For patients with clinically localized prostate cancer, radical prostatectomy has been shown to reduce disease-specific mortality compared with watchful waiting, but a large clinical trial found that the treatment had greater negative effects on sexual and urinary functions and did not improve overall survival. Radiotherapy is another option for treatment, but there have been no studies that directly compare the survival benefits of the two treatments.
To assess the long-term health-related quality-of-life outcomes associated with the treatment of prostate cancer, Arnold L. Potosky, Ph.D., of the National Cancer Institute, and colleagues conducted a prospective cohort study of more than 1,100 men with clinically localized prostate cancer who were treated with either radical prostatectomy or radiotherapy. They compared urinary, bowel, and sexual function reported by the men before treatment, 2 years after diagnosis, and 5 years after diagnosis. This study reports results from the 5-year follow-up.
Five years after diagnosis, overall sexual function--including interest, frequency, and potency--declined in both groups to about the same level primarily because of an increase in the number of men in the radiotherapy group who experienced impotence (defined as insufficient erections for intercourse). At 2 years after diagnosis, 82.1% of the men who received radical prostatectomy experienced impotence compared with 50.3% of those who received radiotherapy. But by 5 years after diagnosis, the percentages were nearly equal--79.3% of men in the radical prostatectomy group experienced impotence compared with 63.5% of those who received radiotherapy.
More patients who were treated with radical prostatectomy experienced urinary incontinence--defined as frequent urinary leaking or no control--(15.3%) compared with those who received radiotherapy (4.1%). However, more men who received radiotherapy experienced bowel urgency (29%) and painful hemorrhoids (20%) than those who were treated with radical prostatectomy (19% and 10%, respectively).
"In the absence of more definitive information from randomized trials comparing treatment groups, these [results] provide new information about the long-term complications of two common treatments for clinically localized prostate cancer to help guide treatment decisions," the authors write.
In an editorial, Ian M. Thompson, M.D., of the University of Texas Health Science Center at San Antonio, and colleagues discuss the need for better evidence of the benefits of prostate cancer treatments and the development of better methods to detect the disease. "It is now time to regroup, develop a national strategy, and invest in the future. It is possible that, with such an investment, within two decades we can achieve the goal of a screening test in an individual man that identifies a cancer that will cause him harm, at a stage when it can be cured, and that specifies treatment that will cure the disease while optimizing quality of life," they write.
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JNCI Journal of the National Cancer Institute