In Today’s issue of The New England Journal of Medicine are the results of a study which tried to: (a) find out what factors determine quality of life (QOL) after primary treatment for prostate cancer, and (b) measure the effects of these factors on overall satisfaction with the treatment outcome as reported by (i) patients and (ii) their spouses or partners. The primary treatments that were studied are: (1) radical prostatectomy (surgery), (2) brachytherapy (radioactive seed implants), and (3) external beam radiation therapy (EBRT) — standard radiation therapy or IMRT — Intensity Modulated Radiation Therapy. In some cases, hormone therapy was added to brachytherapy or EBRT.

Here is a summary of reported side effects for each treatment:

Prostatectomy/ EBRT/ Brachytherapy
Urinary problems 7% 11% 16%
Bowel problems 1% 11% 8%
Sexual problems 43% 37% 30%

*One important finding is that radical prostatectomy (surgery) is a very safe procedure — NO deaths were reported among 1201 patients and serious side effects were rare.*

This study is worth paying attention to because of the highly regarded source, and so I have posted the abstract below

What is unusual about this study is that this is the *first time* spouses and partners of men who have been treated for prostate cancer have been included in a major study of post-treatment quality of life issues and satisfaction levels. This represents a major change.

With more attention paid to the quality of life and satisfaction with treatment reported by both men and women, we will hopefully see health professionals working on ways to ease the burden on patient and partner. I would like to see couples counseling become a standard part of primary treatment for PC. Better long-term results have been observed among patients and partners who were better prepared for side effects after treatment. The fewer surprises the better.

I read in another review of this article that, according to the study, women’s quality of life issues and satisfaction levels were closely related to the *man’s* QOL and satisfaction with treatment outcome. So it seems that if men are unhappy with their treatment, it rubs off on the women.

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New England Journal of Medicine

March 20, 2008

Background

We sought to identify determinants of health-related quality of life after primary treatment of prostate cancer and to measure the effects of such determinants on satisfaction with the outcome of treatment in patients and their spouses or partners.

We prospectively measured outcomes reported by 1201 patients and 625 spouses or partners at multiple centers before and after radical prostatectomy, brachytherapy, or external-beam radiotherapy. We evaluated factors that were associated with changes in quality of life within study groups and determined the effects on satisfaction with the treatment outcome.

Results

Adjuvant hormone therapy was associated with worse outcomes across multiple quality-of-life domains among patients receiving brachytherapy or radiotherapy.

Patients in the brachytherapy group reported having long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function.

Adverse effects of prostatectomy on sexual function were mitigated by nerve-sparing procedures.

After prostatectomy, urinary incontinence was observed, but urinary irritation and obstruction improved, particularly in patients with large prostates.

No treatment-related deaths occurred; serious adverse events were rare.

Treatment-related symptoms were exacerbated by obesity, a large prostate size, a high prostate-specific antigen score, and older age.

Black patients reported lower satisfaction with the degree of overall treatment outcomes. Changes in quality of life were significantly associated with the degree of outcome satisfaction among patients and their spouses or partners.

Conclusions

Each prostate-cancer treatment was associated with a distinct pattern of change in quality-of-life domains related to urinary, sexual, bowel, and hormonal function. These changes influenced satisfaction with treatment outcomes among patients and their spouses or partners.