Relief of urinary symptoms is an underappreciated benefit of early stage prostate cancer treatment
david
Posted On May 20, 2012
Treatment of early stage prostate cancer can also result in improved quality of life for a subgroup of men who suffer from lower urinary tract symptoms (LUTS), according to an abstract of a Beth Israel Deaconess Medical Center-led study presented to the American Urological Association.
LUTS, which includes problems of frequent or urgent urination, particularly at night, is a common problem that affects approximately 40 percent of men, a percentage that rises with age. It is not a reason to suspect prostate cancer.
“Possible benefits of prostate cancer treatment in alleviating lower urinary tract symptoms have been largely overlooked,” says Martin G. Sanda, MD, Director of the Prostate Center at Beth Israel Deaconess Medical Center and Professor of Urology at Harvard Medical School. “We sought to identify pretreatment determinants of urinary function benefit versus worsening due to prostate cancer treatment.”
Researchers prospectively evaluated 1,812 men who underwent prostate removal surgery, radiation therapy and brachytherapy or the implant of radioactive “seeds” across the United States and in Spain. They found use of urinary medications was reduced two years after radical prostatectomy surgery compared to pretreatment, while it was unchanged after radiation and became worse after brachytherapy.
Overall bother from urinary treatment (reflecting combined effects of obstruction or incontinence) was unchanged from pretreatment in 86 percent of the men, improved in 7 percent of the cases and worsened in 7 percent.
Facts about Prostate Cancer
Early-stage prostate cancer means that cancer cells are found only in your prostate. Compared with many other cancers, prostate cancer grows slowly. This means that it can take 10 to 30 years before a prostate tumor gets big enough to cause symptoms or for doctors to find it. Most men who have prostate cancer will die of something other than prostate cancer.
– Prostate cancer is most common in men age 65 and older, although younger men can be diagnosed with it as well.
– By age 80, more than half of all men have some cancer in their prostate.
– African American men tend to be diagnosed at younger ages and with faster-growing prostate cancer than men of other races.
Prostate cancer is most often found in early stages. When it is found early, there are a number of treatment choices available.
“The burden of obstructive lower urinary tract symptoms, which is present in one-third of early stage prostate cancer patients, is underappreciated and deserving of greater emphasis in prostate cancer care decisions,” says Sanda. “Contrary to conventional assumptions, the number of men whose health-related quality of life is benefited by early stage prostate cancer treatment is similar to the number who quality of life is adversely impacted. Men with lower urinary tract symptoms may be particularly likely to have a better quality of life benefit from radical prostatectomy.”
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Coauthors of the study included investigators from the PROSTQA Consortium, funded by the National Cancer Institute, and a team of collaborators from Spain.
Medical Tests
By now you may have had many tests and exams to find out details about your cancer. As we discussed in the section above, your doctor will take into account your general health, the results of your tests and exams, and the Gleason score of your cancer when talking with you about your treatment choices. What are these tests? What do their results mean?
Prostate-Specific Antigen (PSA) test. PSA is a protein that is made by both normal prostate cells and prostate cancer cells. PSA is found in the blood and can be measured with a blood test. Because the amount of PSA in the blood often rises with prostate cancer, doctors may check your PSA level over time. If you have a score of 4ng/ml (which stands for nanograms per milliliter of blood) or higher, your doctor may want to do other tests, such as a prostate biopsy.
Gleason score of your cancer. When you have a biopsy, samples are taken from many areas of your prostate. A doctor called a pathologist uses a microscope to check the samples for cancer. He or she assigns a Gleason score on a scale of 2 to 10 to your cancer. This score tells how different the prostate cancer tissue looks from normal prostate tissue and how likely it is that the cancer will grow or spread. Most men with early-stage prostate cancer have a Gleason score of 6 or 7.
Digital Rectal Exam (DRE). In this exam, your doctor feels your prostate by inserting a gloved and lubricated finger into your rectum.
Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox.
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Jerry Berger
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617-667-7306
Beth Israel Deaconess Medical Center
