Men and their partners speak out on prostate cancer treatments

Summarized by Susan Aldridge, PhD, medical journalist
April 25, 2008

Summary

In a multi-center study, researchers looked at factors that impact health-related quality of life after treatment for prostate cancer for both men and their partners. These included urinary, bowel and sexual problems and issues, such as 'vitality', which have previously been neglected. These factors profoundly influence patient and partner satisfaction with treatment.

Introduction

Prostate cancer can be treated by surgery, brachytherapy (placement of 'seeds' to delivery radiotherapy), external radiotherapy, hormone therapy or 'watchful waiting'. Each approach has an impact on quality of life. For instance, surgery can cause bowel, urinary and sexual problems. But 'watchful waiting' can cause stress and anxiety because nothing 'active' is being done about the cancer. While the physical side effects of surgery for prostate cancer are well established, less is known of how newer treatments, such as brachytherapy, impact health-related quality of life and, therefore, satisfaction with the outcome Nor is much known about the views and feelings of partners and spouses of those surviving prostate cancer. In a new wide-ranging study, researchers from nine hospitals across the United States, led by a team at Beth Israel Deaconess Medical Center, surveyed various issues related to prostate cancer treatments to see how they affected satisfaction with the outcome.

What was done

A group of 1201 patients and 625 partners or spouses were assessed before and after radical prostatectomy, brachytherapy or external-beam radiotherapy. Some patients also had adjuvant hormonal therapy. They were questioned about various health-related quality of life issues, including sexual function, urinary incontinence, urinary function, bowel function, vitality, fatigue, depression and weight change.

What was found

Different treatment choices were linked to specific problems with health-related quality of life. For instance, nerve-sparing procedures in prostatectomy led to a better recovery of sexual quality of life compared to standard surgery. Radiotherapy with hormonal therapy was linked to poorer recovery of sexual function than radiotherapy alone. Older age, larger prostate and higher pre-treatment prostate specific antigen (PSA) score were all linked to worse sexual function after treatment. Partners also reported distress when the patient had a sexual problem after treatment.

Urinary incontinence was worse with older age, black race and high PSA, but prostatectomy could also improve urinary obstruction or irritation. Brachytherapy produced some urinary problems, especially when the prostate was large. Both brachytherapy and radiotherapy also reduced quality of life through impairing bowel function, while prostatectomy did not, on the whole. Hormonal therapy worsened the patient's vitality through leading to hot flashes and depression and these symptoms sometimes persisted after cessation of treatment.

Despite the inconvenience and distress caused by such symptoms, a patient and his partner could still feel the treatment had been worthwhile, if his life had been saved. Accordingly, the researchers asked how these quality of life changes affected satisfaction with overall treatment outcome. They learned that, in descending order, symptoms linked to sexual function, vitality, and urinary function were directly linked to patient satisfaction, or lack thereof. Diminished sexual function was linked to lack of satisfaction on the side of the partner. Black men were significantly less satisfied with their treatment outcome compared to men from other racial backgrounds.

What this means

The researchers note that each kind of treatment for prostate cancer has its own pattern of side effects which affects health-related quality of life. Hormonal therapy leads to long-lasting symptoms and its use in low or intermediate risk cases should perhaps be questioned. Nerve-sparing techniques appear to offer benefit in terms of preserving sexual function, with corresponding improvement in satisfaction with treatment for both patient and partner. It is not clear why the black patients were less satisfied with their treatment, because their care settings were not dissimilar to those of the other patients. Further study is needed to see if there were differences in expectation or some undetected difference in quality of care. The findings should help guide doctors and patients in selecting the treatment options for their cancer, preparing them for what to expect in terms of quality of life outcomes.

Source

• Quality of life and satisfaction with outcome among prostate cancer survivors. MG. Sanda, RL. Dunn,  et al, New England Journal of Medicine, March 20, 2008, vol. 358, pp. 1250--61

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.