Mixed QoL effects after non-hormonal prostate cancer treatment
MedWire News: Sexual dysfunction and urinary problems are common after radical prostatectomy (RP), external beam radiotherapy (EBRT), and brachytherapy (BRT), say researchers who reviewed how non-hormonal prostate cancer treatments impact patient quality of life (QoL).
In addition, patients who undergo EBRT are likely to experience adverse bowel effects.
However, while EBRT and BRT caused urinary irritative-obstructive symptoms and RP caused urinary incontinence, RP actually improved men's pre-existing urinary irritative-obstructive problems.
"These results could provide relevant information to characterize adverse effects of primary treatments and facilitate shared clinical decision-making between patients and professionals," suggest Monserrat Ferrer (Institut Municipal d'Investigacions Mèdiques-Hospital del Mar, Barcelona, Spain) and colleagues.
The cohort included 435 men with clinically localized prostate cancer, 123 of whom were treated with RP, 127 with EBRT, and 185 with BRT. The researchers reviewed sexual, urinary, and bowel function before (baseline) and up to 3 years after treatment, using validated tools including the Short Form-36 Health Survey and the Expanded Prostate Cancer Index Composite (EPIC) scale.
Deterioration of sexual function and urinary incontinence from baseline was greatest in RP patients compared with the other treatment groups, with mean reductions on the EPIC scale of 23.9 and 25.1 points, respectively, report Ferrer et al in the Journal of Clinical Oncology.
Conversely, RP patients showed a mean 6.38-point improvement in urinary irritative-obstructive scores from baseline compared with the other treatment groups. This equated to a 64% overall improvement for nerve-sparing RP patients who had a small-severe urinary irritative-obstructive condition at baseline.
Treatment with radiotherapy was associated with a greater risk for bowel problems compared with surgery. Using all data at baseline, a respective 8% and 6% of EBRT and BRT patients developed severe bowel symptoms after 3 years, compared with less than 1% of RP patients. Among men with pre-existing bowel symptoms, a respective 25% and 20% of EBRT and BRT patients had developed severe bowel symptoms compared with approximately 9% of all RP patients.
In an accompanying editorial, Martin Sanda (Beth Deaconess Medical Center, Boston, Massachusetts, USA) expressed concerns about the exclusion of data in the study regarding men treated with hormone therapy before radiotherapy.
He believes the QoL detriments observed by Ferrer et al could reduce enthusiasm for EBRT and BRT "for which class I evidence of survival benefit, in the absence of concurrent androgen deprivation, remains elusive," he said.
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By Sarah Guy