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Outcomes/Effectiveness Research

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Short-term symptoms of urinary or other dysfunction after brachytherapy for prostate cancer may indicate long-term outcomes

Concerns about treatment-related damage to urinary, bowel, and sexual function influence many men's choice of surgery or radiation treatment for early prostate cancer. However, many of these problems can't be evaluated until years after treatment.

Evidence shows that functional changes continue for 2 or more years after radiation and may not be clearly evident for 5 or more years. The manifestation of urinary incontinence after brachytherapy (radioactive seed implants), for example, appears to be particularly delayed. Radiation dose plausibly mediates both early and late treatment-related urinary toxicity. Short-term symptoms following brachytherapy may signal long-term outcomes, according to a study supported by the Agency for Healthcare Research and Quality (HS08208) and led by principal investigator James A. Talcott, M.D., S.M., of Harvard Medical School.

To examine whether magnetic resonance imaging-guided brachytherapy (MB) results in fewer problems than standard ultrasound-guided brachytherapy (SB), the researchers assessed changes in urinary, bowel, and sexual symptoms among 63 men who received MB and 22 who received SB, using their responses to a questionnaire administered before treatment and 3 months after treatment. Prior to treatment, most men had few urinary incontinence or bowel problems.

The men who received MB, a technique intended to decrease urinary toxicity by reducing urethral irradiation, had a slight increase in urinary obstruction/irritation symptoms and sexual function distress, but not sexual dysfunction. The men who received SB reported a smaller increase in bowel symptoms and bowel distress than MB patients. After 3 months, symptoms of incontinence and related distress increased only slightly and did not differ between the two groups. However, bowel symptoms increased more in the MB group, with an accompanying greater increase in bowel distress. Whether these short-term changes predict long-term outcome differences in the two treatments will require much longer followup. However, these results suggest that measuring early symptoms following brachytherapy may indicate whether an altered brachytherapy treatment technique has intended favorable consequences, potentially accelerating technology assessment.

See "Assessing a prostate cancer brachytherapy technique using early patient-reported symptoms: A potential early indicator for technology assessment?" by Pearl H. Seo, M.D., Anthony V. D'Amico, M.D., Ph.D., Jack A. Clark, PH.D., and others, in the June 2004 Clinical Prostate Cancer 3(1), pp. 38-42.

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