January 30, 2013 | by Shawn Le
Patients with prostate cancer that hasn’t spread beyond the gland itself have a broad range of treatment options – including surgery, radiation therapy and active surveillance. As new research shows, the option they choose can have a large impact on quality of life.
A study published today in the New England Journal of Medicine reports that treatment side effects – such as incontinence, bowel function and erectile function – can last years after prostate cancer treatment. Further, the long-term side effects are similar no matter which immediate treatment was chosen. "Men treated for localized prostate cancer commonly had declines in all functional domains during 15 years of follow-up,” the study found.
Researchers analyzed medical information from 1,655 men age 55 to 74 who had been diagnosed with localized prostate cancer in 1994 and 1995. About two-thirds of the men had the prostate gland removed surgically, known as a radical prostatectomy. The other third underwent radiation therapy. The status of the patients’ urine, bowel and erectile function was assessed prior to surgery, and at two years, five years and 15 years afterward.
At the two-year and five-year marks, men who had chosen surgical treatment were more likely to report incontinence and erectile dysfunction than were those who had chosen radiotherapy. However, patients who had chosen radiotherapy were more likely to experience bowel urgency at those time points.
At 15 years, the researchers said, there was no significant difference between the groups. More than 93 percent of radiotherapy patients, and 87 percent of prostatectomy patients, were affected by erectile dysfunction.
Mark Kawachi, M.D., a surgeon in City of Hope’s Division of Urology and Urologic Oncology, says the study shows that the physician’s experience should be a key factor when patients are choosing a therapy.
“Patients should know that the results reflect the technique of treatment and the experience of the physician providing the treatment,” he said. “Improvements in both surgery and radiation have likely improved outcomes."
The caveat to this study: Many medical advances have been made since 1995. Back then, radical prostatectomy was major, invasive surgery; and minimally invasive surgery using laparoscopic tools was still in early stages for prostate surgery. Now, most prostatectomies are robotic-assisted or laparoscopic.
Today, many surgeons use robotic-assisted surgical systems, which enable them to have greater precision in removing the prostate – done through several small incisions. Minimally invasive surgery offers the potential for faster recovery and fewer side effects.
“Robotic surgery outcomes will likely be much better that open radical surgery outcomes,” Kawachi said. “In our experience with robotic surgery, the potency results are directly related to surgeon expertise.”
Even with new and improved technology, Kawachi says patients usually see better outcomes with more experienced surgeons. “Patients should be very careful of their treatment decisions and go to centers of excellence.”