NEW YORK (Reuters Health) - Different approaches to treating early prostate cancer have different side effects, but this is not always taken into consideration, it seems. A study shows that more than a third of prostate cancer patients receive treatment that is not the most suitable, based on the problems they already have before treatment.
The findings, in the medical journal Cancer, also showed that these patient-treatment "mismatches" led to worse outcomes.
"These 'mismatched' treatments ... either disproportionately increase the likelihood of long-term symptomatic side effects or offer no benefit at an additional risk," lead author Dr. James A. Talcott told Reuters Health.
However, he added, "A patient may be willing to accept those risks because of a countervailing preference, such as a fear of surgery or the inconvenience of getting radiation treatments five times weekly for 8 or 9 weeks."
Talcott, at Massachusetts General Hospital in Boston and colleagues followed 438 patients treated for prostate cancer in the Boston area between 1994 and 2000.
Prior to treatment and periodically over the next 3 years, the men completed questionnaires about difficulties with urination, bowel function or sexual performance.
Before treatment, most of the men reported problems in one or more of these areas; only 11 percent of the patients were free of symptoms. However, treatment of their prostate cancer was often not chosen to minimize the risk of making these problems worse.
For example, pre-treatment urinary problems were aggravated for men who received radioactive seed implants or "brachytherapy," the investigators report.
Similarly, "external beam radiation therapy increased diarrhea, painful bowel movements, bowel urgency, and rectal bleeding in patients with baseline bowel dysfunction."
When it comes to surgical removal of the prostate, a more complicated nerve-sparing procedure may avoid subsequent erectile dysfunction but it offers no benefit for men who already have such problems.
