Prostate Ca treatment choice affects patient, partner quality of life

Men with prostate cancer and their partners face difficult decisions regarding treatment, and outcomes depend on some unexpected factors, according to results of a multicenter study published in the New England Journal of Medicine (2008; 358:1250-61).

Outcomes after prostate surgery, external beam radiation therapy, or brachytherapy are highly individualized and depend not only on age, but also on factors that have been previously overlooked, such as the size of the prostate and whether a man has urinary symptoms due to prostate enlargement before treatment, researchers found.

Led by Martin G. Sanda, MD, of Beth Israel Deaconess Medical Center in Boston, researchers from nine hospitals deduced that outcomes and collateral effects of treatment are equally important in determining overall patient satisfaction.

The study of 1,201 men and 625 spouses examined the impact of the various forms of treatment on quality of life, including not only sexual function, bowel function, and urinary incontinence, but also weak or frequent urination due to BPH as well as a man’s hormonal function.

“We didn’t presume whether one type of side effect or another is more important. Instead, we measured a broad range of side effects and asked how those mesh together and which ones actually matter in terms of either the patient’s or his partner’s satisfaction with the overall cancer treatment outcome,” Dr. Sanda said, adding the research found a greater level of importance than previously thought in a patient’s vitality, which includes concerns expressed by patients and their partners about the patient’s energy level, weight, and mood.

The team found that hormonal therapy, when combined with brachytherapy or with external radiation, worsened multiple aspects of quality of life and had particularly profound effects on men’s vitality and sexuality. Patients receiving radioactive seed treatment experienced problems with weak or frequent urination that lasted longer and had greater effect on overall satisfaction than previously appreciated. Satisfaction with treatment was lower among African-American men, despite having received care at the same centers as their Caucasian counterparts.

In addition, the study confirmed a commonly held belief that treatment-related changes in quality of life among patients had a direct effect on their partners.

“The level of spousal distress arising from a patient’s symptoms after prostate cancer treatment was associated with the partner’s level of satisfaction with the treatment outcome,” the researchers wrote.