Treatment of early-stage prostate cancer may also improve quality of life (QOL) if patients have previously suffered from obstructive urinary symptoms before undergoing treatment, shows US research.
The findings, presented at the American Urological Association 2012 Annual Meeting in Atlanta, Georgia, USA, showed that the annual burden of obstructive lower urinary tract symptoms (LUTS) was significantly alleviated in such men 2 years after surgical removal of their prostate.
"Previously it has been assumed that prostate cancer treatment only causes harm in terms of quality of life, such as causing urinary incontinence, or leaking of urine, in some men despite extending survival and preventing prostate cancer deaths," lead researcher Martin Sanda from Harvard Medical School in Boston, Massachusetts, told MedWire News.
"However, the presence of problematic urinary symptoms in a significant subset of men before they undergo prostate cancer treatment has been largely overlooked."
Sanda and colleagues evaluated pretreatment determinants of urinary function benefit versus urinary function worsening in 1812 men who underwent radical prostatectomy (RP), radiotherapy, or brachytherapy for prostate cancer.
The team performed multivariate regression analysis of the patients' 2-year post-treatment follow-up data on medication usage and any procedures carried out for urinary problems, as well as patient-reported health-related QOL (HRQOL), to identify factors predictive of urinary outcome.
The researchers report that pretreatment urinary symptom scores for obstruction and incontinence, as measured by the Expanded Prostate Cancer Index Composite (EPIC) and the American Urological Association Symptom Index (AUA-SI), respectively, were the most significant predictors for 2-year urinary outcome.
Overall, compared with pretreatment, the bother caused by urinary symptoms was unchanged after 2 years in 86% of men, while it was improved in 7% and also worsened in 7%.
"Contrary to conventional assumptions, the number of men whose long-term urinary HRQOL is benefited by early stage prostate cancer treatment is similar to the number for whom urinary HRQOL is adversely impacted," say Sanda et al.
The team found that the most prominent urinary benefit from prostate cancer treatment was observed among RP patients who had pretreatment incontinence and moderate-to-severe urinary obstruction despite being on medication for LUTS at baseline, with 37% reporting moderate or worse urinary bother at pretreatment, compared with 0% at 2 years post treatment.
"It turns out that for most men who have obstructive urinary symptoms before treatment for prostate cancer (representing about one-quarter of men treated for prostate cancer), from these men's perspective the longer-term benefit of reducing such urinary obstructive symptoms outweighs the possible harms of more temporary urinary incontinence symptoms immediately following treatment," said Sanda.
The researchers plan to validate these findings in a collaboration with a nationwide study in Norway.
"We have also generated simple QOL questionnaires that doctors can use in routine practice to make it possible for them to become more aware of the full spectrum of not only harm but also benefit that prostate cancer survivors can experience two years or longer after treatment," added Sanda.
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