While previous research has documented the effects of prostate cancer treatment on quality of life two years after treatment occurs, this is the first study to look at these issues beyond five years after treatment.
Researchers compared outcomes for men who had undergone surgery, external radiation and brachytherapy, a type of radiation in which seeds are implanted inside the prostate. Results of the study will be presented May 10 at the American Urological Association annual meeting in San Francisco.
Researchers surveyed 1,008 men with and without a history of prostate cancer about quality of life issues, including urinary problems, sexual dysfunction, bowel problems and hormonal concerns. The study participants with prostate cancer had previously been surveyed an average of 2.5 years after their treatment. At this second contact, the men were on average more than six years post-treatment. Current responses were compared against the men without prostate cancer and to the previous survey responses.
"Over the long term, some men who are treated for prostate cancer may continue to have varying degrees of urinary, sexual or bowel dysfunction when compared to men without prostate cancer. When we looked beyond two years of follow-up, we saw quality of life outcomes continue to change for men treated with either type of radiation - some for the better and some for the worse," says lead author David Miller, M.D., a fellow in Urology at the U-M Medical School.
Aging may have contributed to some of these changes, as the external radiation patients were older than those who had undergone surgery, he notes. For men who had surgery, quality of life tended to be stable and their situation at two years was similar to their situation after more than six years.
Regardless of the treatment they received, sexual function received the lower scores than other side effects among prostate cancer survivors, who reported 50 percent lower quality of life in that area compared to men who had not had prostate cancer. The study authors suggest more use of medications and therapies for sexual dysfunction may be beneficial.
"Overall, men are doing quite well in terms of quality of life, regardless of the type of treatment for prostate cancer," Miller says.
Each of the three treatments for prostate cancer studied here are a viable choice for most men diagnosed with prostate cancer, and the research to date does not show one treatment is more effective than the others. That leaves it up to men to weigh the benefits and risks of each treatment and decide which best fits their lifestyle.
"The ability to more precisely characterize long-term quality of life among prostate cancer survivors is essential for several reasons. Newly diagnosed patients can consider this information when making decisions about their treatment options. And men who have already been treated can anticipate these changes in functional status and look for ways to cope. In addition, urologists and radiation oncologists can look for ways to refine these therapies to treat the cancer while minimizing the side effects," Miller says.
In addition to Miller, study authors are Martin Sanda, M.D., director of the Prostate Cancer Care Center at Beth Israel Deaconess Medical Center in Boston; Rodney Dunn, UMHS research associate; Hector Pimentel; James Montie, M.D., professor and chair of Urology; Howard Sandler, M.D., professor of Radiation Oncology; P. William McLaughlin, M.D., professor of Radiation Oncology; and John Wei, M.D., assistant professor of Urology.
Funding for the study was from the National Institutes of Health and the U-M Department of Urology.