Since the latest treatment options for early-stage prostate cancer are thought to be similar in their effectiveness, choosing the best treatment can come down to side effects. A recent study sheds new light on those side effects.

Study details: Researchers looked at more than 1,100 early-stage prostate cancer patients whose treatment was either active surveillance (frequent monitoring to check for cancer growth but no immediate treatment)…complete removal of the prostate (radical prostatectomy)…external beam radiation…or brachytherapy (the implanting of radioactive seeds).

Finding: Prostatectomy was linked to a higher incidence of sexual dysfunction (characterized by difficulty achieving and maintaining erections and the ability to achieve orgasm) and urinary leakage than the other options. The two radiation treatments caused worse short-term urinary obstruction and irritation, with external beam radiotherapy causing worse bowel symptoms. But at the two-year mark, the differences in side effects were negligible between active surveillance, external beam radiation and brachytherapy—indicating that urinary obstruction, irritation and bowel symptoms associated with external beam radiation and brachytherapy improved over time. However, after two years, 57% of men undergoing radical prostatectomy who had normal sexual functioning prior to surgery reported poor sexual function after, as well as more urinary leakage than men who chose the other options.

This is the first comparison of quality-of-life outcomes since major advances have been made in both surgical and radiation therapies. Aware that the modern techniques are roughly equal in efficacy, researchers from the University of North Carolina’s Lineberger Comprehensive Cancer Center wanted to study the side effects of the improved therapies so patients and doctors could select the most appropriate treatment. Patients were studied within five weeks of diagnosis and followed for two years, reporting on a quality-of-life index measuring sexual dysfunction, urinary obstruction and irritation, urinary incontinence and bowel problems. Results were published in JAMA: Journal of the American Medical Association.

Bottom Line: If you’re diagnosed with prostate cancer, consider your options carefully and discuss both short-term and long-term side effects with your doctor so that you can choose the treatment that aligns best with your priorities.

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