- The Washington Times - Thursday, March 20, 2008

ATLANTA (AP) — One of the first large quality-of-life studies on today’s prostate-cancer treatments suggests that for some men, it’s a matter of picking your poison and facing potential sexual, urinary or other problems.

Of the choices studied — surgery, standard radiation, hormone therapy or radioactive seeds — the seeds seemed to carry a lower risk of several of these side effects.

Hormone therapy — when combined with radiation — had a big effect on men’s vitality and sexuality. The radioactive pellets sometimes led to sexual problems too, but more often involved discomfort in urinating.

The research, published in today’s New England Journal of Medicine, doesn’t address the cure rates of different treatments. Moreover, not every treatment is an option for every man. For example, radioactive pellets are generally used only in men with early-stage cancer that is slow-growing.

Nor does the study speak to decisions about whether to treat at all a slow-growing form of cancer — the second-deadliest for American men — that can take 10 or 20 years to become life-threatening.

An 80-year-old man may choose to avoid all treatment and the assorted complications. But for a man of, say, 50, the study provides some insight into the side effects of different options, said Dr. William Oh, a Harvard University prostate-cancer specialist.

“We’ve just never had the data that put patients side by side like this before,” said Dr. Oh, who was not involved in the study.

The researchers surveyed about 1,200 patients, as well as 625 wives, who were enrolled at nine U.S. hospitals from March 2003 to March 2006. Telephone surveys were done before treatment began and at two, six, 12 and 24 months afterward.

Nearly 300 of the men in the study underwent brachytherapy, which involved the implant of radioactive pellets (often called “seeds”) in the prostate to kill cancer cells.

About 300 got more-conventional radiation treatments beamed at a tumor. And nearly 600 had their prostate tumors surgically removed, with most of them undergoing nerve-sparing procedures intended to minimize the operation’s effect on sexual performance.

About 90 got hormone therapy in addition to conventional radiation, and some got it in addition to brachytherapy. Hormone therapy, which suppresses testosterone production, is used to enhance radiation treatment and improve survival.

Although life-threatening side effects were rare, men in all the groups experienced, to varying degrees, problems with urinating, achieving erections and moving their bowels.

No procedure was clearly best or worst across the board.

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