Fox Chase Cancer Center Study Shows Men Who Had Radiation Therapy for Prostate Cancer Prefer Treatment Over No Treatment and Rate Quality of Life "Quite Good"
PHILADELPHIA (Oct. 7, 2002)-A Fox Chase Cancer Center study designed to assess the treatment preferences, health states ("utilities") and quality of life among men with prostate cancer shows that men feel more satisfied about having treatment, despite side effects, than simply being placed under observation-known as "watchful waiting." By evaluating potential predictive factors, the study may help identify how well future patients cope with specific treatment side effects and assist in decision making about the best treatment for an individual.
Deborah Watkins Bruner, Ph.D., director of the Prostate Cancer Risk Assessment Program at Fox Chase, presented the study results Monday, Oct. 7 at the 44th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO) held in New Orleans Oct. 6-10.
"If you ask healthy men how they would feel about possible side effects of prostate cancer treatment, such as impotence or urinary incontinence, many-about two-thirds-say they would rather give up several years of life than have to cope with these conditions," Watkins Bruner said. "But our study found that when men actually face the situation, they're not willing to trade off those life years even if it means living with side effects."
The Fox Chase study assessed 56 men, with a mean age of 63 years, who received treatment for prostate cancer during the 1990s using three-dimensional conformal radiation therapy. This type of external radiation, pioneered at Fox Chase, shapes the radiation beam to the prostate gland and helps reduce damage to nearby normal tissue. Statistics show the risk of incontinence for radiation therapy is 10 percent and the risk of impotence is 40 percent.
In addition to watchful waiting and radiation therapy, other options widely available at this time included surgery-radical prostatectomy to remove the prostate gland. Although surgeons may be able to do a nerve-sparing procedure, which avoids cutting the nerves that control erections, the size and location of the tumor may not make this possible. As a result, statistics show up to a 30 percent risk of incontinence and an 80 percent risk impotence after surgery.
Another treatment is hormone therapy, using medication that vastly lowered levels of the male hormone testosterone, which can promote the growth of prostate cancer. This therapy does not pose a risk of incontinence but leaves virtually all men impotent. Of the men in the Fox Chase study, 30 percent received hormone therapy along with radiation therapy.
The researchers asked study participants how they value a treatment with a 10 percent or a 30 percent risk of incontinence and how they value a treatment with a 40 percent, 80 percent or 99 percent risk of impotence-mirroring the potential risks of these side effects associated with radiation therapy, surgery or hormone therapy.
The patients studied felt satisfied with their choice of radiation, but even with the greater risk of side effects from the other treatments, they expressed a preference for these treatments over no treatment at all.
"All aspects of quality of life were rated quite good with the exception of sexual function," Watkins Bruner explained. "Scores on the Sexual Adjustment Questionnaire were low, but urinary function scores were excellent. Overall quality of life scores were higher than those reported among a mixed population of patients with different types of cancer."
Predictive factors for impotence included hormone therapy and unmarried status. Being married was associated with better sexual adjustment.
Predictive factors for incontinence included older age and higher radiation dose. However, higher radiation doses were also associated with a higher value placed on survival, regardless of the risk of poorer health states or the risk of incontinence.
Not surprisingly, more advanced tumors at diagnosis were associated with lower rated health states. Higher income predicted higher scores for overall quality of life.
Other authors of the study include biostatistician Alexandra L. Hanlon, Ph.D., and health educator Susan Mazzoni, M.P.H., of Fox Chase Cancer Center and retired radiation oncology chairman Gerald E. Hanks, M.D.
Fox Chase Cancer Center, one of the nation's first comprehensive cancer centers designated by the National Cancer Institute in 1974, conducts basic and clinical research; programs of prevention, detection and treatment of cancer; and community outreach. For more information about Fox Chase activities, visit the Center's web site at www.fccc.edu.
Fox Chase Cancer Center, part of Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase also was among the first institutions to receive the National Cancer Institute’s prestigious comprehensive cancer center designation in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are routinely recognized in national rankings, and the Center’s nursing program has achieved Magnet status for excellence three consecutive times. Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research and oversees programs in cancer prevention, detection, survivorship, and community outreach. For more information, call 1-888-FOX-CHASE (1-888-369-2427).