Prostate news article, September 2005
| HAS THE QUALITY
OF LIFE BEEN CONSIDERED AFTER TREATMENT FOR PROSTATE CANCER?
Jo Y, Junichi H, Tomohiro F, Yoshinari I and Masato F. Article in: British Journal of Urology International (2005); 96 (1): 43-47 Reviewed by: Dr Tom Swallow BSc MBBS MRCS |
Radical prostatectomy versus high-dose rate brachytherapy for prostate cancer: effects on health-related quality of life.
It is confusing times for men with prostate cancer. The decision over which therapy to choose has become clouded due to the number of options as well as the similar outcomes. The options for men with prostate cancer confined completely to the prostate are: watchful waiting, external beam radiotherapy, brachytherapy and radical prostatectomy. Most of the data availabale suggests that there is not much between these options in terms of outcomes. However what is not normally taken into account is the quality of life proffered by these options afterwards. It is known that each one has side effects that can guide a decision. For example a radical prostatectomy could leave the patient with impotence or incontinence problems, compared with brachytherapy causing problems in urinating. Although the side effects are, generally, accepted by the patient, the impact that they will have on the patient’s quality of life is not always considered.
A recent study from Japan has looked at the quality of life of men after either a radical prostatectomy or brachytherapy. In men with localised prostate cancer, the researchers used two models of assessing the quality of life. One was multidimensional and included physical, psychosocial and emotional status, and is applicable to various medical conditions. The other is a disease specific quality of life model used for evaluating treatments of early-stage prostate cancer.
Over a period of 5 years, a total of 182 men were treated with prostatectomy or brachytherapy. In total during a follow up period of 6 to 64 months, 151 men responded to the questionnaires that were sent to them. The men (81) who received brachytherapy also had external beam radiotherapy afterwards as well. Also of note, hormonal therapy preceded 12 of the 70 prostatectomy patients compared to 34 of the brachytherapy patients. Of the prostatectomy patients, about 40% had unilateral nerve-sparing operations, none had bilateral nerve-sparing.
As for the results the general quality of life questionnaire showed no significant difference between the prostatectomy and the brachytherapy group in overall outcome. For the disease specific quality of life questionnaire the brachytherapy group were associated with better urinary and sexual function when compared to the prostatectomy group, regardless of unilateral nerve-sparing.
Not surprisingly their results compare well with other studies that have looked at quality of life issues. However this study does not take into account the patient’s preceding quality of life and therefore makes no firm conclusions about treatment related changes.
In deciding which therapy is going to be the best suited, patients and their Urologist will need to carefully discuss the options. It would be sensible to carry out a preceding quality of life questionnaire as well as careful counselling of all the side effects. Only then can a patient make an informed and impartial choice on the treatment for their prostate cancer.