Urinary, bowel, sexual problems persist long after localized prostate cancer therapy

Treatment-specific complications relating to urinary, bowel, and sexual function persist 5 years after radical prostatectomy (RP) or external beam radiotherapy (EBRT) for clinically localized prostate cancer, results of a study in the September 15th Journal of the National Cancer Institute indicate.

“Given uncertainty about the survival benefits of any single treatment strategy, this information may be useful for helping men make more informed treatment decisions to suit their preferences,” Dr. Arnold L. Potosky, the NCI researcher who led the study told Reuters Health.Dr. Potosky and colleagues analyzed 5-year urinary, bowel, and sexual function outcomes for 1100 men with newly diagnosed clinically localized prostate cancer who underwent RP (n = 901) or EBRT (n =286). They compared the 5-year outcomes data with 2-year data reported previously.As Dr. Potosky explained, “RP patients experience larger declines in overall sexual function than EBRT patients in the first 2 years after therapy, but EBRT patients ‘catch up’ in the sense that they experience larger declines in sexual functioning between 2 and 5 years after treatment. Thus, overall function (includes libido, frequency, erectile function) reach nearly similar levels at 5 years.”For erectile function in particular, at 2 years, 82.1% of RP patients reported this problem compared with 50.3% of ERBT patients. At 5 years, these figures were closer at 79.3% and 63.5%, respectively.At 5 years, urinary incontinence affected considerably more RP than EBRT patients (15.3% vs 4.1%). Compared with 2-year data, there was “not much change [in urinary incontinence] from 2 to 5 years in either group,” Dr. Potosky noted.At 5 years, bowel urgency and painful hemorrhoids were more common in ERBT patients (29% and 20%, respectively) than in RP patients (19% and 10%, respectively).Dr. Potosky believes more study is needed comparing mortality and quality-of-life outcomes following all prostate cancer therapies now being used in clinical practice, including radioactive seeds and hormonal therapies.In an editorial, Dr. Ian M. Thompson of the University of Texas Health Science Center at San Antonio and co-authors comment that this study provides “powerful evidence about the long-term morbidity of prostate cancer treatment.””As such, it is a clarion call for a focused, long-term investment at the national level to address seminal questions regarding prostate cancer detection and treatment,” they write.”It is possible that, with such an investment, within two decades we can achieve the goal of a screening test in an individual man that identifies a cancer that will cause him harm, at a stage when it can be cured, and that specifies treatment that will cure the disease while optimizing quality of life,” they conclude.(Source: J Natl Cancer Inst 2004;96:1348-1349,1358-1367: Reuters Health News: Megan Rauscher: Oncolink: September 2004.)