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Complications from prostate cancer treatment vary according to pretreatment function and choice of treatment

More than 140,000 men in the United States are diagnosed each year with localized prostate cancer. Most men undergo one of four types of therapy, each of which has a distinctive pattern of long-lasting effects on urinary, bowel, and sexual function. Treatments include external beam radiation therapy (EBRT, a radiation beam is targeted at the diseased cells), radical prostatectomy (RP, surgical removal of the prostate), interstitial radioactive seed implants (radioactive seeds are placed in the tumor and remain in the body, where they give off radiation for about a year), or brachytherapy (BT, also called internal radiation therapy, in which a doctor pushes radioactive seeds through needles into the prostate gland, where they release radiation over a 3-6 month period).

None of these treatments have yet been proven to prolong life; most patients die of something other than prostate cancer. Thus, understanding the quality-of-life differences following these treatments might improve patients' choice of treatment and later help them adjust to its consequences, explains James Talcott, M.D., of Massachusetts General Hospital. In a recent study supported by the Agency for Healthcare Research and Quality (HS08208), Dr. Talcott and his colleagues prospectively studied 417 men with localized prostate cancer. They assessed the men's urinary, bowel, and sexual function from before treatment to 24 months after.

Patients who underwent EBRT, RP, and BT differed significantly in sociodemographic factors, cancer prognostic factors, and pretreatment symptom status, especially sexual function. Average scores for measures of urinary incontinence increased sharply after RP, while bowel problems and urinary irritation/obstruction rose after EBRT and BT. Sexual dysfunction increased in all patient groups, particularly after radical prostatectomy; nerve-sparing surgical technique had little apparent benefit. There was no improvement in urinary function and little change in overall bowel function after 12 months. However, the time course of sexual dysfunction varied by treatment and, for bowel function, by symptom.

More details are in "Time course and predictors of symptoms after primary prostate cancer therapy," by Dr. Talcott, Judith Manola, M.S., Jack A. Clark, Ph.D., and others, in the November 1, 2003, Journal of Clinical Oncology 21, pp. 3979-3986.

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