Local stage or regional stage prostate cancer is treated successfully today, with nearly 100 percent 5-year survival rates, according to American Cancer Society figures. Those rates are about the same for prostate cancer surgery and radiation therapy. For many, the similar success rates of both brings the decision on prostate cancer surgery vs. radiation down to quality-of-life issues. So how do these treatments stack up in terms of impact on quality of life?
The most common quality-of-life issues after both surgery and radiation treatments are sexual, urinary and bowel problems. A 2013 study, published in the British Journal of Cancer, compared these issues in patients after treatment with prostate cancer surgery vs. radiation. Results were as follows:
Sexual side-effects – Surgery patients had lower sexual function scores than radiation patients, and more surgery patients experienced a clinically relevant deterioration from baseline over 12 months. Additionally, patient questionnaires revealed that 39 percent of external beam radiation (EBRT) patients, 36 percent of brachytherapy (BT) patients and 8 percent of surgery patients were able to achieve erections firm enough for intercourse at 12 months post-treatment.
Urinary problems – Summary scores for urinary function were lower in surgery patients, and more deterioration from baseline was observed as compared to radiation patients. Patient questionnaires showed that 96 percent of BT patients, 89 percent of EBRT patients, and 61 percent of surgery patients did not need incontinence pads at 12 months post-treatment.
Bowel issues – No significant differences were observed in prostate cancer vs. radiation patients.
While there has been previous research on this issue, this particular study has some unique qualities. Firstly, unlike most previous studies, patients were specifically chosen for comparable characteristics at baseline, which means before treatment. This was done to ensure that study subjects started out under similar conditions, especially in terms of factors known to affect post-treatment quality of life, such as age and pre-treatment function levels. The benefit of this, according to study authors, is that it would yield a more unbiased comparison.
Secondly, radiation methods were more advanced than those used when many high-profile comparison studies were conducted. Participants who received EBRT were treated with intensity modulated radiation therapy (IMRT), which targets the prostate more accurately than older methods, and endorectal balloons were used to limit rectal radiation exposure. Researchers believe these differences contributed to their differing results from those of previous comparisons — most significantly in prevalence of bowel/rectal issues after radiation.
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