"We would look at these changes and say they are meaningful," said Dr. John Wei, a professor of urology at the University of Michigan who was not involved in the study.
Even though their urinary and sexual health rebounded about a year after treatment, surgical patients were still six times more likely to have urinary incontinence and 3.5 times more likely to erectile dysfunction two years after treatment than radiation patients.
"The trajectory of the lines is different," Resnick said. "Obviously surgery is much more of an acute insult than radiation."
However, men who received radiation therapy reported greater early loss in bowel function, from a score of about 90 to 75. Although they went on to recover some function, the men who had surgery were 39 percent and 47 percent less likely to report bowel urgency two and five years later, respectively.
"I have been telling patients for years about these types of differences associated with prostate cancer treatment," Wei said.
This study gives a reference point when explaining these issues to patients, Wei said, adding that he applauds the authors for following the men in this study for 15 years.
By 15 years after treatment, the declines were in the same range for both treatment groups. Men reported a score of between 70 and 80 for urinary function, about 20 for sexual function and 80 for bowel function.
Nonetheless, "I would be somewhat careful in showing the results [of this study] to my patients," Wei said.
Intensive prostate cancer treatments are done differently today; for example, surgery can be done with a robot or with minimally invasive laproscopy using small incisions in the abdomen. Cancers also tend to be detected earlier when they are less aggressive, and so treatment could be less aggressive.
These differences could add up to lower side-effect rates, Wei said.
In the end, it comes down to what men decide with their doctors. Some men may worry about the invasiveness of surgery and opt for radiation therapy, whereas others might prefer surgery because they feel more comfortable knowing that their prostate has been removed and there is no chance of recurrence of prostate cancer, Wei said.
For more about prostate cancer and treatments, visit the U.S. National Library of Medicine.
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