Prostate treatment side effects detailed
Study compares patients' options
ATLANTA - One of the first large quality-of-life studies on today's prostate cancer treatments suggests that for some men, it's a matter of picking your poison and facing potential sexual, urinary, or other problems.
Of the choices studied - surgery, standard radiation, hormone therapy, or radioactive seeds - the seeds seemed to carry a lower risk of several of these side effects.
Hormone therapy, when combined with radiation, had a big effect on men's vitality and sexuality. The radioactive pellets sometimes led to sexual problems, too, but more often involved discomfort in urinating.
The research, published in today's New England Journal of Medicine, doesn't address the cure rates of different treatments. Moreover, not every treatment is an option for every man. For example, radioactive pellets are generally used only in men with early-stage cancer that is slow-growing.
Nor does the study speak to decisions about whether to treat at all a slow-growing form of cancer that can take 10 or 20 years to become life-threatening.
An 80-year-old man may choose to avoid all treatment and the assorted complications, but for a man of, say, 50, the study provides some insight into the side effects of different options, said Dr. William Oh, a Harvard University prostate cancer specialist.
The researchers surveyed about 1,200 patients, as well as 625 wives, who were treated at nine US hospitals from March 2003 to March 2006. Telephone surveys were done before treatment began and two, six, 12, and 24 months afterward.
Nearly 300 of the men in the study underwent brachytherapy, which involved the implanting of radioactive pellets in the prostate to kill cancer cells.
About 300 got more conventional radiation treatments. And nearly 600 had their prostate tumors surgically removed, with most of them undergoing nerve-sparing procedures intended to minimize the operation's effect on sexual performance.
About 90 got hormone therapy in addition to conventional radiation, and some got it in addition to brachytherapy. Hormone therapy is used to enhance radiation treatment and improve survival.
Although life-threatening side effects were rare, men in all the groups experienced, to varying degrees, problems with urinating, achieving erections, and moving their bowels.
No procedure was clearly best or worst across the board.
The wives of about 13 percent of men who had brachytherapy said they were distressed by problems with their partner's erections one year after treatment.
The spouses of about 22 percent of the men in the traditional radiation group and 44 percent in the surgery group reported that concern.
