Article date: 2001/09/18

Two newly-published studies on the long-term side effects of treating early prostate cancer with surgical removal of the prostate (radical prostatectomy) or radioactive seed implants (brachytherapy) can help men make better-informed choices about which treatment may be best for them, say cancer experts.

“Which treatment is better in terms of survival is being studied, but is not yet known, so men may make decisions more on the quality of life after treatment, and these studies can help with that,” says William Eley, MD, MPH, author of several earlier studies on both therapies, a member of the American Cancer Society executive council, and associate dean of student affairs at Emory University School of Medicine in Atlanta.

In Los Angeles, researchers studied 247 men who chose radical prostatectomy as treatment, and in Boston researchers studied 105 men who had brachytherapy, including 33 who also were treated with external beam radiotherapy (XRT). Both studies were published in the August 2001 issue of The Journal of Urology.

Quality of life (QOL) in several areas was measured among the surgery patients before their operations and at several points afterwards; the radiotherapy patients’ QOL was measured at an average of five years after treatment.

Urinary Control Slightly Better With Prostatectomy

Three months after surgery, about one-fifth of the prostatectomy patients felt they had no more leakage of urine than before their operation; a year after surgery, more than half felt that way; by three years after surgery, almost two-thirds felt they were back to pre-operation levels of bladder control.

Among radiotherapy patients, urine leakage was a problem for more than half of men whose therapy combined external beam radiation and radioactive seed implants, and for 40% of those who had only the seed implants.

Sexual Function Got Better With Time in Surgery Patients

Among the surgery patients, at three months almost one-fifth felt their sexual function was as good as before treatment, and a year after surgery, one-third thought so. By three years after surgery, almost half felt they had back pre-op levels of sexual function.

About half of the radiotherapy patients reported having no erections in the month prior to being surveyed, and almost three-quarters had not had an erection sufficient for penetration without manual assistance.

Bowel Problems Fewer with Brachytherapy than External Radiotherapy

Among surgery patients, more than two-thirds thought they recovered pre-operation levels of bowel function three months after surgery; 96% thought so a year after surgery, and 98% thought so three years after surgery.

Among radiotherapy patients, bowel problems occurred in less than 5% of those who got only the seed implants. In men who got both the seed implants and external beam radiation, almost 20% reported bowel symptoms.

New Info Can Help Patients Focus on Long-Term Effects

Summarizing the results of the brachytherapy study, lead author James A. Talcott, MD, says, “Urinary incontinence appears to be a long-term risk of brachytherapy as it was practiced six to 10 years ago, but there doesn’t appear to be as great a risk of bowel problems as there is from external beam radiotherapy.”

Talcott says newer brachytherapy techniques now used may result in fewer urinary problems because the seeds are placed farther from the urethra. That could mean more bowel problems if dosage to that organ increases, but that remains to be seen, he notes.

“The risk of sexual problems is at least of a comparable order of magnitude for brachytherapy as for the other major treatments for prostate cancer,” notes Talcott, who is director of the Center for Outcomes Research at the Massachusetts General Hospital Cancer Center in Boston.

Summarizing the results of the prostatectomy study, its lead author, Mark S. Litwin, MD, MPH, says, “The main take-home message of this study is that men who are recovering from prostatectomy should keep the faith, that improvement does continue, for one year, two years, or longer after treatment.” Litwin is associate professor of urology and of public health at UCLA.

Studies Needed to Directly Compare Survival

Eley says that the continuing recovery of prostatectomy patients and the relatively small extent of bowel problems among the brachtherapy patients compared to XRT are reassuring, useful, and can help men make treatment decisions.

“And some older men with prostate cancer that is histologically not very aggressive may reasonably choose not to have immediate treatment, so a full discussion of treatment options with one’s doctor is crucial for those with prostate cancer,” he notes.

“But there still is no data from large-scale studies that directly compare the ability of each of these treatments to lengthen these patients’ lives,” notes Eley. “This is a large, unfulfilled need, and doctors should encourage men to enroll in such studies where appropriate and when available,” he adds. “That will help prostate cancer patients immeasurably,” he concludes.

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