Treatment for prostate cancer leads to significant five-year declines in sexual and urinary function, according to a new study. However, general and other specific health-related quality of life factors, such as bowel function, are not affected.
These findings come from the first prospective comparative study examining differences between normal aging and the effects of prostate cancer treatment, published in the November 1, 2004 issue of CANCER, a peer-reviewed journal of the American Cancer Society.
Generally a very slow progressing cancer, early prostate cancer is treated aggressively with radiation or radical prostatectomy. However, only one study, on surgical removal of the prostate, has proven therapeutic benefit of treatment compared with observation. Meanwhile, treatments themselves are often associated with significant adverse effects, such as impotence and urinary incontinence. To date, studies have been unable to distinguish between the normal effects of aging and the adverse effects of treatment, confounding any informed decision-making about which treatment to use.
In the first prospective comparative quality of life analysis of prostate cancer patients and matched healthy subjects, Richard M. Hoffman, M.D., M.P.H., of the New Mexico Veterans Administration Health Care System in Albuquerque, New Mexico and his colleagues compared the effects of cancer treatment versus aging in men over a five-year period.
They found even healthy subjects reported declines in sexual function over the five years. But the decline among patients treated for prostate cancer over that same time period was much greater, and was accompanied by significant declines in urinary function as well. General and other specific health-related quality of life factors were not affected by cancer.
The authors conclude, "declines in urinary and sexual functional domains after diagnosis and treatment of localized cancer far exceeded any effects from aging, particularly for men undergoing radical prostatectomy."
What is the prostate?
The prostate is a gland in the male reproductive system. The prostate makes and stores a component of semen and is located near the bladder and the rectum. The prostate surrounds part of the urethra, the tube that empties urine from the bladder. A healthy prostate is about the size of a walnut. If the prostate grows too large, the flow of urine can be slowed or stopped.
What is prostate cancer?
Except for skin cancer, cancer of the prostate is the most common malignancy in American men. It is estimated that nearly 221,000 men in the United States will be diagnosed with prostate cancer in 2003. In most men with prostate cancer, the disease grows very slowly. The majority of men with low-grade, early prostate cancer (confined to the gland) live a long time after their diagnosis. Even without treatment, many of these men will not die of the prostate cancer, but rather will live with it until they eventually die of some other, unrelated cause. Nevertheless, nearly 29,000 men will die of prostate cancer in 2003.
Who is at risk for prostate cancer?
All men are at risk. The most common risk factor is age. More than 70 percent of men diagnosed with prostate cancer each year are over the age of 65. African American men have a higher risk of prostate cancer than white men. Dramatic differences in the incidence of prostate cancer are also seen in different countries, and there is some evidence that a diet higher in fat, especially animal fat, may account for some of these differences. Genetic factors also appear to play a role, particularly for families in whom the diagnosis is made in men under 60 years of age. The risk of prostate cancer rises with the number of close relatives who have the disease.
What are the symptoms of prostate cancer?
Prostate cancer often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate. When symptoms do occur, they may include:
- Frequent urination, especially at night
- Inability to urinate
- Trouble starting or holding back urination
- A weak or interrupted flow of urine
- Painful or burning urination
- Blood in the urine or semen
- Painful ejaculation
- Frequent pain in the lower back, hips, or upper thighs
These can be symptoms of cancer, but more often they are symptoms of noncancerous conditions. It is important to check with a doctor.