Jun 10, 2009
Study Details Quality of Life for Prostate Cancer Patients Four
Years Out From Treatment
June 10, 2009
A long-term study by researchers at UCLA's Jonsson Comprehensive
Cancer Center found that the three most common
treatments for localized prostate cancer had significant impacts on
patients' quality of life, a finding that could help guide doctors
and patients in making treatment decisions.
The four-year study followed 475 men treated for early stage
prostate cancer. It also resulted in the development of
"probability plots," gauges which can be used to predict when
treatment side effects such as urinary incontinence, sexual
dysfunction or bowel problems might return to normal, or whether
the patient will ever fully recover. Such predictions could be used
to determine whether further treatments or surgeries are needed to
deal with adverse side effects, said Dr. John Gore, a urologist and
the study's first author.
The study appears June 9 in the early online edition of the Journal
of the National Cancer Institute.
"These probability plots are more helpful than the normal
functional trajectory curves that are used," Gore said. "They allow
people to point toward where the function level is currently and
predict what it might be in the future. Is a patient's
incontinence, for example, likely to get better? If not, the doctor
and patients may agree to proceed with treatment options such as
drugs or surgery."
The study is unique because it is not a cross-sectional review.
Rather, researchers knew what a patient's baseline function was
prior to treatment. That way, Gore said, they had a target to shoot
for in judging recovery from side effects. The goal was to get the
patient back to the function level experienced before treatment, if
possible.
The researchers studied the quality of life in men who either
underwent radical prostatectomy, implantation of radioactive seeds
in their prostate gland, or had external beam radiation therapy.
The three treatment options rank about equally in survival outcomes
for most men, so specific impacts on quality of life become
paramount in making treatment decisions, said Dr. Mark Litwin, the
study's senior author, a professor of urology and a researcher at
UCLA's Jonsson Cancer Center.
"The good news is that the patients' overall mental and physical
well-being were not profoundly affected by any of the three
treatment choices," Litwin said. "That's good news for men with a
diagnosis of prostate cancer hanging over their heads. In general,
they'll be OK, no matter which of the three options they choose."
The study found that urinary incontinence was more common among
patients who underwent prostatectomy than those who had seed
implants, called brachytherapy, or external beam radiation. Sexual
dysfunction was found in patients in all three treatment groups.
Surgery patients were less likely to regain baseline sexual
function than were patients who underwent external beam radiation.
Bowel dysfunction and irritable bladder were more common after
either form of radiation therapy than after prostatectomy.
Study patients were given comprehensive questionnaires to fill out
before treatment to assess generic and prostate cancer-specific,
health-related quality of life. Questionnaires were filled out
again at one, two, four, eight, 12, 18, 24, 30, 36, 42 and 48
months after treatment to "capture maximal fluctuations in
functional convalescence," the study state.
The most rapid change in the slope of patient recovery came very
early after treatment, Gore said, either for better or worse.
However, once more than two years had passed, the patient's
recovery or decline had stabilized.
The study patients were diagnosed with the most common type of
prostate cancer, low-risk, clinically localized disease. Many of
the patients were older men and already were experiencing
age-related functional issues such as erectile dysfunction, so each
had individual baseline goals to achieve.
The study will allow oncologists to look at the patient, look at
the characteristics of their cancer and determine what treatment
will mostly likely help them to achieve their baseline
health-related quality of life. For example, a patient with an
existing irritable bladder condition should probably not receive
external beam radiation because the treatment could exacerbate the
underlying condition. A patient's acceptance of potential side
effects also should be considered.
"Different men are bothered by different things, so it depends on
what their baseline function is," Litwin said. "If a man is already
impotent, for example, loss of sexual function won't be an issue in
making a treatment decision."
Funding for the study came from the California Department of Health
Services.
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