Quality of life following prostate cancer treatment: 'More than a data point'

"Quality of life is more than just a data point to your patients," said John Wei, MD, MS, associate professor of urology at the University of Michigan, Ann Arbor. "Quality of life reflects the real impact that a therapy has on a man's life and it is often outside the typical clinical outlook. Clinicians need to counsel patients on the potential quality of life effects of each treatment."

However, this is not always easy to do.

Whether a particular complication actually bothers the patient also presents a challenge to the provider. Stress incontinence may be a minor irritation to a man who spends most of his working day sitting behind a desk, but it may matter a great deal to a factory worker who experiences urinary incontinence every time he picks up something heavy.

"Don't worry about the statistics; worry about your patient," Dr. Wei advised.

Same questions, different answers

The difference in reported complications after treatment, Dr. Wei said, depends on who is being asked to report the complication, when the question is asked, and how it is asked. In one study, researchers who asked patients about their urinary incontinence using a strict definition 12 months after radical prostatectomy found that 47% perceived a problem. However, when researchers examined the documentation of urinary incontinence by the physician for these same patients, only 10% were noted to have urinary incontinence.

When the question is asked can also make a significant difference. Asking about urinary incontinence, sexual dysfunction, or other problems 3 months after treatment will likely elicit very different answers than will posing the same questions at 6 months, 12 months, or 5 years.

How the question is asked also affects the response. One study asked patients if they had "complete control" of urinary function versus whether they needed to use a urinary pad. While 80% of patients reported that they either did not require pads or used a single pad daily, 40% of patients reported complete urinary control.

All prostate cancer treatments impact quality of life, Dr. Wei noted. The key for the physician is to explain in understandable terms precisely what treatment, or lack of treatment, may mean to a specific patient.

Typical areas of concern include urinary incontinence, urinary irritation, sexual function, bowel function, and hormonal function/vitality. The most common treatments for localized prostate cancer, radical prostatectomy, external beam radiation therapy, and interstitial brachytherapy all have different effects that present at different times.

Prostatectomy, for example, tends to have more sexual dysfunction and urinary incontinence early on, he noted. In contrast, external beam radiation and brachytherapy tend to affect bowel and sexual, and urinary function in a more delayed fashion. Improvement in function is generally slower following either type of radiation therapy.