Radioactive seed implantation for early stage prostate cancer can significantly impair a patient's quality of life, according to a new study by researchers at UCLA's Jonsson Cancer Center.
The findings, published in the March issue of the Journal of Urology, challenge the popular perception that prostate cancer patients who undergo radioactive seed implantation, called brachytherapy, experience better quality of life than patients who undergo radical prostatectomy, or surgery to remove the prostate gland.
Within three to 17 months after finishing treatment, patients in this retrospective study completed questionnaires about their emotional and social functions and physical strength and dexterity, as well as urinary, bowel and sexual functions.
Researchers compared quality of life in 48 prostate cancer patients who received seed implants, with or without external beam radiation, with quality of life in 74 patients who underwent surgery.
"Many physicians and patients assume that seed implantation will not have a significant impact on quality of life, but according to our study, that's not true. The effects of seed implantation on a patient's sexual, urinary and bowel function can be significant and patients need to be aware of this when they're considering treatment options," said Dr. Robert Reiter, co-author of the journal article, associate director of the Prostate Program Area at UCLA's Jonsson Cancer Center and an assistant professor of urology at the UCLA School of Medicine.
Although men in the seed implant and surgery groups experienced similar quality of life in terms of physical strength and dexterity and emotional and social functions, the researchers were surprised to find that, on average, patients who underwent seed implantation had significantly more problems with bowel and urinary functions, such as bleeding, diarrhea, burning, and urinating too frequently or too slowly, than men who had surgery.
"We also were surprised to see that patients in the seed implant groups experienced impotence at rates similar to patients in the surgery group," said Dr. Mark Litwin, co-author of the journal article, a researcher at UCLA's Jonsson Cancer Center and an assistant professor of Urology at the UCLA School of Medicine. "This finding contradicts previous suggestions that as many as 75 percent of patients who undergo seed implants maintain their potency after treatment. However, the earlier studies were based primarily on physicians' reports, whereas our study relied on patients' self-assessments."
On average, men in the surgery group experienced worse incontinence than those who received seed implants, although men in the seed implant groups reported frequent bouts of incontinence.
In addition to comparing prostate cancer patients who received seed implants with those who underwent surgery, the study for the first time compared quality of life in patients who received seed implants alone with those who received seed implants and external-beam radiation. For about 25 percent of patients with aggressive prostate cancer, external beam radiation is an important part of their treatment because seed implants alone cannot effectively curb their disease.
"Patients need to know that they are more likely to experience worse quality of life in all categories if they undergo seed implantation plus external beam radiation instead of seed implantation alone," Litwin said.
Quality of life has become an increasingly important issue in treatment selection because no single treatment option for prostate cancer has clearly demonstrated a survival advantage, Reiter said.
"The bottom line is that all prostate cancer treatments affect a patient's quality of life, and men need to discuss this fact openly and honestly with their physicians before they decide which particular treatment option is best for them," Reiter said.
UCLA researchers are planning future studies to further investigate quality of life in prostate cancer patients. - By Kambra McConnel
[Contact: Kambra McConnel, Kim Irwin]