Treatment options for localized prostate cancer – comparing long-term adverse effects

This study aimed to identify health-related decline in quality of life 4 to 8 years after prostate cancer (PC) treatment. Main finding: measures of quality of life vary based on therapy choice.

Treatments for localized PC (confined to the prostate gland) include radical prostatectomy (RP), brachytherapy (BT) and external radiation therapy (ERT). RP involves the surgical removal of the entire prostate gland. BT involves placing a radiation source inside the prostate. ERT uses a machine that sends targeted beams of radiation from outside the body towards the prostate. BT and ERT are collectively referred to as ‘radiotherapy‘. Any of these treatments may have long-term side effects on urinary, bowel or sexual function.

The study included 709 men who answered a standardized questionnaire which evaluated patients’ quality of life through sexual, urinary and bowel functions. Participants were PC survivors and healthy men of similar age for comparison (non-cancer controls). Patients were initially checked-up at approximately 2.6 years after treatment. The same questions were asked again 4 years later in order to assess improvement/deterioration in quality of life.

Results: urinary incontinence (involuntary leakage of urine) tends to improve within 2 years after RP, while continuing to deteriorate among men treated with BT and/or ERT. Symptoms related to urinary irritation or obstruction (pain or burning on urination) significantly improved within 8 years post-treatment in men treated with BT. Bowel and rectal symptoms (including diarrhea, painful bowel movements, and rectal bleeding) were worse after radiotherapy (particularly BT) compared to RP; however, these tend to improve in the first 2 years of follow-up. Sexual dysfunction (erectile dysfunction or impotence) was more severe in the ERT group. Quality of life remained stable between 2 and 6 years of follow-up after RP, meaning that symptoms among these men neither improved nor deteriorated during this time. This finding suggests that RP-related side effects are mainly influenced by the extent of surgical resection. Higher surgical volume is associated with fewer side effects.

In summary, this survey showed that urinary, bowel and sexual dysfunction represents a significant concern among early-stage PC treatment survivors, compared with healthy men. Adverse effects were more pronounced after radiotherapy.

However, this is a relatively small trial based on patients from a single medical center. Also, quality of life before treatment was not assessed.