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Treatments for early prostate cancers are often incongruent with previous conditions

When physicians propose one of four treatment approaches for early prostate cancer, many fail to consider how the treatment will affect the patient's ongoing urinary, bowel, or sexual dysfunction, a new study finds.

Massachusetts researchers found that 89 percent of 438 men diagnosed with early prostate cancer had preexisting conditions, and one-third of them received treatments that worsened those conditions more than other treatments would have. For example, brachytherapy delivers radiation to the prostate but can also cause urinary obstructions, making it a poor treatment option for those who have urinary problems. Patients with urinary problems who received this treatment reported a surge in nighttime urination from 78 percent to 90 percent and a rise in painful urination from 8 percent to 34 percent.

External beam radiation, which irradiates the nearby rectum and can cause long-term bowel dysfunction, poses problems for patients with preexisting bowel problems. Patients who underwent this treatment suffered diarrhea and bowel urgency (32 percent pretreatment, 43 percent after), painful bowel movements (7 percent vs. 32 percent), and rectal bleeding (8 percent vs. 32 percent). Radical prostatectomy can cause erectile problems, so two versions are offered: one that spares the nerves and one that doesn't. However, men who already suffer from erectile dysfunction do not regain sexual potency after undergoing the nerve-sparing procedure. Doctors were more likely to perform the nerve-sparing surgery for younger men (average 58.2 years old) than older men (61.4 years old).

The authors state that candid discussions between patients and physicians are paramount when treatment options for prostate cancer are discussed. These could be facilitated by using clinic questionnaires that ask questions patients might be uncomfortable answering verbally to ensure patients with preexisting conditions are matched with the appropriate treatment. This study was funded in part by the Agency for Healthcare Research and Quality (HS08208).

See "Treatment 'mismatch' in early prostate cancer: Do treatment choices take patient quality of life into account?" by Ronald C. Chen, M.D., Jack A. Clark, Ph.D., Judith Manola, M.S., and others in the January 1, 2008, Cancer 112(1), pp. 61-68.

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