The quality of life men have after prostate cancer is influenced by the type of treatment they choose, a recent study confirms. Researchers found that two years out, patients do better in areas like sexual function and urinary incontinence after having certain currently available treatments versus others.
"Prostate cancer is very, very common," said lead author Dr Gary Chien, who is director of the urology residency program at Kaiser Permanente in Los Angeles. "One out of five men are diagnosed with it in their lifetime. In addition to cancer cure one of the things physicians and patients want to achieve is quality of life." Chien and colleagues write in BJU International that previous studies examined whether men could be cured and preserve their urinary and sexual function. Many of those studies were not comprehensive and many are out of date, they authors add.
For the new study, the researchers analyzed surveys completed by 5,727 men in the Kaiser Permanente health system who were diagnosed with prostate cancer from March 2011 to January 2014. The men averaged 64 years old. Participants answered surveys about their quality of life before their treatment and again one, three, six, 12, 18 and 24 months later - until November 2014. The survey asked about urinary incontinence and irritation, sexual function, bowel function and hormone issues.
Overall, 2,389 men had active surveillance, which only monitors the cancer without intervening, 1,861 had their prostates removed with robotic surgery and 828 had the hormone treatment known as androgen-deprivation therapy. Another 309 had external radiation, 199 had their prostates removed with traditional open surgery, 132 had internal radiation and nine had cryoblation, a technique to destroy the tumor by freezing it. The researchers found that sexual function declined after all treatments, compared to the active surveillance group. Men who had their prostates surgically removed had the greatest decline in function, but it was less severe with the robotic procedure compared to men who had open surgery.
By the end of 24 months, men who had the robotic procedure were on a par in terms of sexual function with men who had either of the two types of radiation treatment. Urinary incontinence was also worst after surgical prostate removal compared to active surveillance. Of all the treatments, only the hormonal therapy was not associated with worse incontinence compared to active surveillance.
Differences among the other quality of life measures were not as extreme, and the findings are similar to those of past research, the authors note. Intuit Surgical, maker of robotic surgery equipment, funded the study. The researchers can't tell whether the differences between treatments in function levels afterward are significant enough to be noticeable to patients, Chien said.
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