© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 19, 1545,
October 4, 2000
© 2000 Oxford University Press
MEMORANDUM FOR: Science Writers and Editors on the Journal Press List
New Study Compares the Side Effects of Surgery Versus Radiation Treatment for Localized Prostate Cancer
September 28, 2000 (EMBARGOED FOR RELEASE 4 P.M. EDT October 3)
A major study reports that men whose localized prostate cancer was treated with surgery had more urinary and sexual problems than men treated by radiation, while men treated with radiation had greater declines in bowel function than the surgery group.
Prostate cancer is diagnosed in 180,000 men in the United States each year, of whom approximately 90% have clinically localized cancers. The two main treatment options with curative intent for localized prostate cancer are surgery—radical prostatectomy—and external beam radiation, both of which can have major side effects. Because the prognosis for localized prostate cancer is usually favorable regardless of treatment, the chance of experiencing side effects may be a crucial factor affecting choice of treatments. Arnold Potosky, Ph.D., of the National Cancer Institute, and colleagues, studied 1,591 men aged 55–74 years from six geographic regions who had been treated for localized prostate cancer to determine their after-treatment functioning. Of this total, 1,156 men received radical prostatectomy and 435 received radiotherapy as their primary treatment within the first year of diagnosis. Their results, the first to directly compare the two major treatments in a diverse group of patients treated in all types of health care delivery settings, appear in the Oct. 4 issue of the Journal of the National Cancer Institute.
Over a 2-year period following treatment, men receiving radical prostatectomy had larger declines in urinary as well as sexual function than did men receiving radiotherapy. Men in the radical prostatectomy group recovered some urinary and sexual function during the second year after treatment, while men in the radiotherapy group remained the same or became slightly worse during the second year. Almost 2 years after treatment, men receiving radical prostatectomy reported more urinary incontinence (9.6% versus 3.5%), were more likely to wear pads to stay dry (28.1% versus 2.6%), and were more bothered by their incontinence (11.2% versus 2.3%) than men receiving radiotherapy. More men receiving radical prostatectomy reported being impotent (79.6% versus 61.5%), although loss of sexual libido was similar in both treatment groups. The extent to which men were bothered by their loss of sexual function was similar by treatment group among men ages 60 years and older, but among men ages 55–59 years, the radical prostatectomy patients were more bothered than radiotherapy patients (59.4% versus 25.3%).
While radical prostatectomy had very little effect on bowel function, radiotherapy patients experienced a decline in bowel function within the first 4 months of receiving treatment but recovered some function over the 2-year period. However, some bowel complications persisted during the second year, particularly bowel urgency and painful hemorrhoids. At 2 years, men receiving radiotherapy reported more diarrhea (37.2% versus 20.9%) and bowel urgency (35.7% versus 14.5%) than did men receiving radical prostatectomy, although the percent of men who were bothered by bowel dysfunction was fairly small and did not differ by treatment group.
No clear differences in general health-related outcomes, such as emotional and mental health, or overall physical health status were observed between the two treatment groups.
The authors conclude that their study demonstrates that treatment choice, baseline function, and age are the key determinants of changes in urinary, bowel, and sexual function. The authors note that, in the absence of definitive evidence establishing the superiority of radical prostatectomy versus radiation for clinically localized prostate cancer, this study provides the most comprehensive and representative information yet collected about long-term complications of the two treatments to help guide and inform treatment decisions by patients, their families, and clinicians.
Contact: NCI Press Office, (301) 496-6641. (Note: The media contact for this paper is the NCI Press Office because the author is on the NCI staff.)
Note: This memo to reporters is from the Journal staff and is not an official release of the National Cancer Institute (NCI) or Oxford University Press (OUP) nor does it reflect NCI or OUP policy. In addition, unless otherwise stated, all articles and items published in the Journal reflect the individual views of the authors and not necessarily the official points of view held by NCI, any other component of the U.S. government, OUP, or the organizations with which the authors are affiliated. Neither NCI nor any other component of the U.S. government nor OUP assumes any responsibility for the completeness of the articles or other items or the accuracy of the conclusions reached therein.
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