Surgery v. Radiotherapy - Different Impacts on Quality of Life, Dutch study finds
Early detection does not reduce side effects

March 18, 2001. Treatment for prostate cancer has a considerable impact on a patient’s quality of life, regardless of the therapy used, or how early their cancer was initially detected, a Dutch study has concluded. Done within the framework of a screening trial, this study was designed to compare the health-related quality-of-life (HRQOL) outcomes of two primary treatment modalities for localized prostate cancer:

• surgical removal of the prostate gland (radical prostatectomy)
• or external beam radiation treatments (radiotherapy).

Questionnaires about sexual, urinary and bowel function were given to 278 patients. The questions were put at baseline, 6 months and 12 months. Of the roughly ninety percent who replied, most (59%) had cancers that had been detected early by screening. The rest (41%) had been clinically diagnosed, in a regular health care setting on the basis of health complaints.

Impacts on erection, urination and bowel

Radiotherapy patients were "significantly older" than prostatectomy patients (63 v 68 years). After adjusting for age and pretreatment health levels, radiotherapy patients still felt that they had poorer levels of overall health-related quality of life.

This difference emerged even though prostatectomy patients reported much higher rates of urinary incontinence and impotence. Urinary incontinence and bother affected 39% to 49% of the Dutch surgery patients compared to 12% to 13% of the men who took radiotherapy.

As for erectile dysfunction, 80% to 91% of surgery patients reported this compared to only 41% to 55% of radiotherapy patients.

But bowel problems (urgency) affected 30% to 35% of the radiotherapy group versus only 6% to 7% of the prostatectomy group. Patient's feelings about bowel urgency may be even stronger than about loss erectile dysfunction. One year after treatment, radiation patients reported more limitations because of physical and emotional problems than prostatectomy patients.

Patients treated with radiation compared to prostatectomy rated their quality of life lower -- their physical health at 72/100 vs. 89/100 and their emotional health at 83/100 vs. 93/100 respectively. (None of the patients received radiatiotherapy in the form of brachytherapy.)

Patients with screen-detected and clinically diagnosed cancer reported similar posttreatment health-related quality of life. "Prostatectomy and radiotherapy differed," the authors conclude, "in the type of HRQOL impairment. Because the HRQOL effects may be valued differently at the individual level, patients should be made fully aware of the potential benefits and adverse consequences of therapies for early prostate cancer." Differences in posttreatment HRQOL were not related to the method of cancer detection.

"On the basis of this study, we cannot conclude that one treatment is preferable over the other," said the lead author Joanna Madalinska, M.A., M.Sc., of the Department of Public Health at Erasmus University in Rotterdam. "Each results in different consequences, and it’s important that patients have easy access to unbiased information about possible side effects of the treatments."

This part of Madalinska's study did not look at any impact of early detection and/or treatment choice on recurrence and survival. In an earlier report on a baseline study of 200 patients, she reported that "screen-detected tumors were of more favorable stages and grades than clinically diagnosed ones."

The latest report focused on HRQOL says early detection made no difference in quality of life outcomes during the first year after treatment. Of note, early-detected patients had somewhat higher HQOL at baseline. "Treatment seems to be the most important determinant of health-related quality of life, with no short-term quality of life benefits found with early detection." Madalinska said. The Dutch team is currently investigating the long-term effects of screening on quality of life and overall survival.

Read abstract of this study: Health-Related Quality-of-Life Effects of Radical Prostatectomy and Primary Radiotherapy for Screen-Detected or Clinically Diagnosed Localized Prostate Cancer By Joanna B. Madalinska, et al. From the Departments of Public Health, Erasmus University, and Department of Urology, Erasmus University Rotterdam and Academic Hospital Rotterdam, the Netherlands. Journal of Clinical Oncology, Vol 19, Issue 6 (March), 2001: 1619-1628

See also: Health-related quality of life in patients with screen-detected versus clinically diagnosed prostate cancer preceding primary treatment. Madalinska JB, et al. Prostate. 2001 Feb 1;46(2):87-97.