Prostate cancer brachytherapy

NEW ORLEANS--Brachytherapy led to a significantly worse quality of life in men treated for localized prostate cancer, compared with external beam radiation and radical prostatectomy.

"Brachytherapy was less favorable in the bother related to urinary and bowel function," Dr. Martin G. Sanda said at the annual meeting of the American College of Clinical Oncology.

When weighing options for treating localized prostate cancer, patients and their physicians "need to assess not only incontinence, but also irritative and obstructive symptoms," added Dr. Sanda, a urologist at the University of Michigan in Ann Arbor.

He and his associates surveyed all men who were treated for localized prostate cancer at his hospital during the period June 1995 to June 1999; the patients' mean age was about 67.

There were 902 responses, a 75% response rate.

Also included were 112 age-matched men without prostate cancer who served as control subjects. They completed four separate instruments designed to assess quality of life.

The results were adjusted to account for differences in age, time from therapy to the survey, and baseline cancer severity, Dr. Sanda said.

About 70% of the men had undergone radical prostatectomy, about 20% were treated by external beam radiation, and about 10% had undergone brachytherapy.

The survey was completed a mean of 21-30 months following treatment, and no men were surveyed less than 4 months after treatment.

More than 20% of the men treated with brachytherapy reported urinary symptoms that were moderately to severely bothersome. In contrast, symptoms of this severity were reported by fewer than 10% of the men treated with either external beam radiation or by radical prostatectomy and by 6% of the control men.

A similar pattern was seen for bothersome bowel function symptoms. Moderate to severe symptoms were reported by more than 15% of men treated by brachytherapy, compared with less than 10% of men treated with external beam radiation, and by less than 5% of men treated with surgery.

Complaints about sexual function were similar among all three treatment groups. Bothersome symptoms related to adjuvant hormonal therapy were significantly worse in the men treated with either brachytherapy or external beam radiation.

This study did not include a baseline assessment of quality of life. But results from prior studies showed that quality of life is similar among the men who opt for each of the treatment options in this study, Dr. Sanda said.