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Spring 2007

Facts Help Patients Choose Prostate Cancer Treatments

Survival is the number-one goal for patients and their doctors when choosing among the several established treatment options after a diagnosis of early-stage prostate cancer. But often, the best option isn’t always clear, and patients find themselves facing difficult choices among therapies that have varying potential side effects—effects that, given the high success rates of localized prostate cancer treatment and the slow-growing nature of most prostate tumors, they are likely to live with for many years.

To assist patients and their doctors in making these difficult decisions, UCLA’s Prostate Cancer Program has ongoing studies of quality-of-life outcomes after the four major types of treatment for localized prostate cancer: minimally invasive robotic prostatectomy, nerve-sparing radical prostatectomy, radioactive seed placement and external-beam radiation therapy. “Each affects urinary, sexual and bowel functions differently,” says Mark S. Litwin, M.D., M.P.H., professor of urology and public health. “The goal is to obtain measurements that are as objective as possible on these effects.”

Measurements were obtained using a questionnaire given to patients prior to treatment and periodically for two years after the treatment. The UCLA urologists have found that surgery has the most effect on urinary continence, while radiation has more of an impact on other urinary symptoms such as frequency and burning. Sexual function is affected by all treatments, but improves over time, particularly if the nerves are spared to preserve potency. Radiation causes more bowel symptoms than surgery.

The quality-of-life measurements, developed by Dr. Litwin, provide a more accurate measure than ever before of how patients are affected by the treatments, not only because of the use of patient-answered questionnaires rather than physician reports, but also because how patients felt before the treatment is incorporated in the findings. “Every patient weighs the importance of post-treatment symptoms differently,” explains Robert Reiter, M.D., urologist and co-director of the UCLA Prostate Cancer Program. “It is important to provide them with all of the treatment options and to explain in an objective way, based on what other patients have experienced, the likely effects of each treatment.” 

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