1. Chu, Julie MSN

Article Content

According to this study:


* Changes in quality of life related to sexual, urinary, bowel, and hormonal function after prostate cancer treatment affect patients' (and their partners') satisfaction with treatment outcomes.



Treatment of prostate cancer with radical prostatectomy, brachytherapy (implanting radioactive seeds in the prostate), or external-beam radiotherapy affects patients' quality of life in the areas of urinary, sexual, bowel, and hormonal function, according to this study. Patients' and their partners' satisfaction with treatment outcomes are affected by these changes.


Researchers studied 1,201 patients with prostate cancer (mean age, 63 years) who were scheduled to undergo prostatectomy, brachytherapy, or external-beam radiotherapy. They and their 625 spouses or partners were surveyed regularly about quality of life before treatment and at two, six, 12, and 24 months after the start of treatment. Brachytherapy alone was performed in 271 patients; 35 patients had concomitant external-beam radiotherapy, androgen-suppression hormone therapy, or both. External-beam radiotherapy alone was administered in 202 patients; 90 patients received adjuvant androgen-suppression hormone therapy as well. Prostatectomy was performed in 561 patients using nerve-sparing techniques; non-nerve-sparing prostatectomy was performed in 41 patients. The type of treatment given to the final patient was unavailable.


Each treatment caused distinct changes in the quality of life of both patients and their partners. Sexual quality of life was significantly affected in patients in all treatment groups: 44% of partners in the prostatectomy group, 22% in the radiotherapy group, and 13% in the brachytherapy group reported distress related to the patient's sexual dysfunction. Nerve-sparing prostatectomy was associated with better sexual functioning than non-nerve-sparing prostatectomy. Urinary incontinence improved for most patients over time; however, those who underwent brachytherapy reported worse distress from overall urinary symptoms at one year. Quality of life related to bowel function was worst for those who underwent brachytherapy or radiotherapy. Patients who received adjuvant hormone therapy with brachytherapy or radiotherapy suffered significant worsening of distress over issues of vitality (such as fatigue and depression) related to hormonal function. Obesity, large prostate size, high baseline prostate-specific antigen score, older age, and black race were associated with worse patient outcomes.


The quality-of-life changes reported were significantly associated with patient and partner satisfaction with treatment outcomes.




Sanda MG, et al. N Engl J Med 2008; 358(12):1250-61.