Comparing Local Prostate Cancer Treatments

Question: I have prostate cancer that has not spread outside of the prostate and I don't know which treatment to choose. Which treatment is best for me?

Answer: This question is on the minds of thousands of men in the U.S. every year, and until recently there has been no definitive answer.

But a recent long-term study on the quality of life for men that have undergone treatment for localized (Stage I or Stage II) prostate cancer shows the answer is up to you.

The researchers determined that the three most popular treatments: brachytherapy, external beam radiation therapy (EBRT), and prostatectomy, all had very similar survival outcomes, so determining the best treatment depends on a patient's preferences. With all three treatments, the overall mental and physical well-being were not profoundly affected. However, each treatment did negatively affect certain aspects of the study participants' quality-of-life, with side effects ranging from urinary incontinence to sexual dysfunction -- which can be temporary or permanent.

This study is tracking almost 600 men for five years, and the results of the first two years are published in a 2007 journal article in Cancer.

A summary comparison of the three treatments:

External Beam Radiation Therapy (EBRT)

• Best urinary control outcomes (low obstruction and bladder control problems)
• Sexual function problems were low
• Bowel symptoms similar to brachytherapy:
  • diarrhea
  • frequency
  • urgency
  • pain with bowel movements

Brachytherapy

• Shortest recovery times (but not quite "implants on Monday, golf on Tuesday")
• Urine obstruction common
• Loss of urine control and urinary irritation more common than with EBRT
• Sexual function problems were lowest
• Bowel symptoms similar to EBRT:
  • diarrhea
  • frequency
  • urgency
  • pain with bowel movements

Prostatectomy

• Higher rates of urinary incontinence (when sneezing or coughing)
• Higher rate of sexual dysfunction
• Many fewer bowel problems than with EBRT or brachytherapy
• Generally higher rate of sexual dysfunction (now better due to new surgical "nerve-sparing techniques").

The team will continue to analyze the study data through the five-year point, but they expect little to change, as most symptoms will resolve to their final level by two years post-treatment.

Analysis: This research clearly points out that it is important for men to make treatment choices based on their own needs and priorities. For instance, if you don't want to lose your ability to obtain an erection, you may choose brachytherapy.

It must be stressed that each man facing prostate cancer finds the best doctor available for the treatment, as the research has shown that experience of the doctor and the facility do make a significant difference in the quality of the outcome.

_{Research Source: Mark S. Litwin, John L. Gore, Lorna Kwan, Judson M. Brandeis, Steve P. Lee, et. al. (2007). Quality of life after surgery, external beam irradiation, or brachytherapy for early-stage prostate cancer. Cancer. (abstract)}