Survey gauges side effects of prostate treatments

By Gene Emery
Age, race and obesity affect how satisfied men are with their treatment for prostate cancer, U.S. researchers said on Wednesday.
And the effects of short-term hormone therapy can linger for years, the survey of 1,201 men treated at nine university hospitals and 625 of their partners found.
The results, published in the New England Journal of Medicine, are designed to give doctors and patients a better idea of what to expect from three types of prostate cancer treatment.
"I don't think our findings are going to make any one of the specific approaches a winner," said Dr. Martin Sanda of Beth Israel Deaconess Medical Center in Boston.
"But they do make it possible for doctors and patients to better gauge what to expect for treatment A or treatment B," Sanda said.
One year after treatment, sexual functioning was a moderate or big problem among 50 percent of men whose prostate had been removed, the researchers found.
It was a problem for 31 percent treated with external radiation and 30 percent who had radioactive seeds placed in the prostate. Surgery to spare the nerves, they found, helped prevent sexual problems.
"Overall, 10 to 19 percent of patients or their partners reported being distressed by symptoms attributable to hormonal therapy," the researchers wrote, adding that the finding raises questions about whether hormone therapy should be restricted to high-risk cases.
Therapy designed to block the male hormone testosterone for six months had effects on sexuality and vitality that persisted for up to two years, the doctors found. Such treatments are usually combined with nonsurgical
therapy.
RACE A MAJOR FACTOR
"The one factor that really stood out across all the different treatments was that African-American men were less satisfied with their outcome," said Sanda.
"It could be differences in expectations, if doctors are not communicating as effectively. Another possibility is that the aggressiveness of prostate cancer tends to be worse for them," Sanda added.
"I think a lot of unhappiness that people experience with prostate cancer may be because the specific information about what will happen has not been all that available in a way that is really relevant to their concerns, which differ from patient to patient," he said.
Urinary incontinence was a moderate or big problem in 8 percent of surgery patients, 5 percent of seed patients and 4 percent of radiotherapy patients.
Other types of urinary problems, such as having to go frequently, having trouble emptying the bladder or having a slow stream, were reported as a significant problem in 18 percent of seed patients, 14 percent of men getting radiation and 12 percent of those treated with surgery.
One surprise, said Sanda, was that men who had a large prostate before treatment found urination easier after surgery. "They actually did better when the prostate was removed," he said.
Bowel problems were also less common after surgery. Only 2 percent said it was a moderate or big problem, compared to about 10 percent in the men receiving other treatments.
Nine percent of surgery patients reported a loss of vitality, compared with 18 percent treated with radiotherapy and 15 percent who received the radioactive seeds.