The various forms of prostate cancer treatment — from surgery to radiation to hormones — can all have long-term effects on men's quality of life when it comes to sexual function and urinary problems, a new study finds.
On the other hand, researchers found, none of the treatments seemed to have strong effects on other aspects of men's overall quality of life — including energy levels, pain, emotional well-being, and ability to perform day-to-day physical tasks, like walking, climbing stairs, and carrying groceries.
The findings, reported in the Journal of Urology, are based on 1,269 U.S. men who were followed for four years after treatment for earlier-stage prostate cancer.
The majority — 60 percent — underwent radical prostatectomy, surgical removal of the prostate gland. Another 17 percent had brachytherapy, an internal form of radiation therapy in which radioactive "seeds" are implanted in the prostate gland, and 12 percent had externally delivered radiation.
Another 6 percent of patients had a combination of the two radiation therapies, and 5 percent were treated with drugs that block the male hormones that feed prostate cancer growth.
It's well known that all of these treatments can cause erectile dysfunction, and that surgery and radiation often lead to urinary incontinence. But much less has been known about how these problems affect men's quality of life in the long run, according to the researchers, led by Dr. George J. Huang of the University of Pittsburgh School of Medicine.
The issue is important because while prostate cancer is one of the most common cancers in men, affecting about 160 per 100,000 every year and killing 26 of those 100,000, most tumors grow slowly and never cause any harm.
In this study, the researchers found that, in general, men who had surgery or any form of radiation saw their urinary symptoms worsen in the first year after treatment, based on their responses to standard quality-of-life questionnaires. As a group, surgery patients had the most problems.
Then, in the second year after treatment, the surgery and radiation groups all showed a general improvement in urinary symptoms — though they did not fully return to their pre-treatment quality-of-life ratings. The extent to which the men were "bothered" by their urinary problems also waned, moving close to their pre-treatment ratings.
Men who underwent hormone therapy showed a different pattern: They tended to report a gradual, moderate worsening in their urinary function over four years.
The finding, Huang and his colleagues write, is somewhat surprising and the reason for it is not clear. They speculate that hormonal therapy may have effects on the pelvic muscles and urinary tract that, over time, can create urinary problems — in a manner similar to the way natural estrogen declines can affect women's urinary continence after menopause.
When it came to sexual function, all of the treatment groups reported declines in the first year after treatment — with the steepest drop seen among surgery patients. However, surgery patients also showed an improvement over the second year, whereas the other treatment groups did not — such that men who had surgery were faring similarly to other men at the end of the study period.
In addition, while men in all of the treatment groups tended to say they were more bothered by sexual problems after treatment than before, their "bother scores" declined less than their objective ratings of sexual function.
"This finding," Huang and his colleagues write, "provides indirect evidence suggesting that while erectile dysfunction may be common, patients seem to adjust to these changes."
And when it came to men's ratings of their overall quality of life, none of the prostate cancer treatments seemed to have a significant impact.
"All treatment types," the researchers write, "adversely impact urinary and sexual function, but do not appear to significantly impact the overall sense of well-being."
The decision over the type of prostate cancer therapy to pursue must be made on an individual basis, by men and their doctors. But knowing what to generally expect in terms of long-term quality of life can help in guiding those decisions, the researchers say.
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