Many men must cringe when choosing among prostate cancer treatments. I know I do, at least, when reading about the various options available to cut out, fry, or freeze (a technique that recently got a boost from this research) the offending cells. Yet it's a choice many of us will have to make: 1 in 6 men gets the cancer, and it's no secret that going after the tumor aggressively with surgery or radiation can leave our plumbing malfunctioning permanently.
Obviously, then, it's a decision we should make armed with good data on the possible cure rates and side effects of treatment. But, for various reasons, that data have been largely unavailable. (I've blogged before about the confusing and muddled science that men face when it comes to choosing a treatment.) Well, this week, we got at least a glimmer of clarity. The New England Journal of Medicine has published a nine-center study that offers men some insight on what to expect as far as quality of life goes for three of the major treatments—prostatectomy, external-beam radiotherapy, and brachytherapy. Here are the percentages of men receiving the various treatments who reported worsened urinary, bowel, or sexual function after treatment.
It's not a perfect study. Its two-year follow-up, for example, is too short to draw firm conclusions from. And it's a phone survey, not a randomized trial directly comparing the treatments. Therefore, it doesn't tell us which treatment is "best," but it does give us some real numbers on what men experienced after receiving the various treatments.
(Some technical details: The radiation was either IMRT or another highly conformal technique. Prostatectomy was either retropubic, laparoscopic, or robot-assisted laparoscopic; some patients received a nerve-sparing surgery, some did not. Some men received hormonal therapy or radiation in conjunction with the brachytherapy. The 1,201 men surveyed had stage T1 or T2 prostate cancer.)
The authors also made some other interesting observations:
- Adverse side effects were exacerbated by obesity, having a large prostate, a high prostate-specific antigen or PSA score, and old age.
- Black patients report lower overall satisfaction with their treatment outcomes.
- Hormone therapy worsened the side effects of radiotherapy or brachytherapy.
- Nerve-sparing surgery resulted in fewer adverse effects than did surgery overall.