Mismatch Treatments for Prostate Cancer Often Avoidable

(Defeat Diabetes® News) -- Preexisting sexual, urinary and bowel dysfunction can potentially hinder the effectiveness of prostate cancer treatment, and can often exacerbate these problems.

The three most prevalent forms of treatment for prostate cancer are external beam radiation (EBRT), radical prostatectomy (RP) and brachytherapy (BT). Each of these three treatments is known to cause
varying degrees of bowel, urinary and sexual dysfunction. Patients with past or present exposure to any of these dysfunctions are at increased risk for them to be worsened by an improper choice of prostate cancer treatment.

According to a study done at Massachusetts General Hospital of 438 patients, more than one-third of the 389 (89%) patients who reported preexisting dysfunction received mismatched prostate cancer treatments that worsened their preexisting condition of dysfunction. Patients were asked to fill out surveys indicating preexisting urinary, bowel and sexual conditions, and whether these conditions had been discussed with their doctor's prior to treatment. The survey's showed that the high level of mismatched treatment is most likely due to improper communication between the physician and patient.

The published findings of the study, authored by lead researcher Dr.James A. Talcott of Massachusetts General Hospital and five of his colleagues, states that "Because such dysfunction may indicate a
patient's increased vulnerability to a specific treatment modality or his inability to benefit from it, pretreatment [preexisting] dysfunction needs to be explicitly communicated between patient and physician and factored into the treatment decision-making process."

For example, a patient who does not communicate to their doctor that they have symptoms of urinary obstruction, in addition to a doctor neglecting to do a thorough examination of preexisting dysfunction,
may be matched with BT as a treatment. In BT, very high levels of radiation are administered to the prostate, and often causes further painful urinary obstruction for patients with preexisting dysfunction.
EBRT and RP do not have this effect, and would be more appropriate forms of treatment in this hypothetical case.

Alternatively, for those with preexisting bowel dysfunction, EBRT is a mismatched treatment due to inevitable radiation delivered to the rectum during the treatment, and RP and BT would be better forms of treatment.

RP is often chosen as a treatment because of its "nerve-sparing" technique that limits damage to sexual function. This treatment is less effective in eradicating cancerous tissue in the prostate. For a patient with erectile dysfunction, RP is considered a mismatch treatment because the intended benefit for the patient is in an already dysfunctional area, and is done at the sacrifice of a more effective cancer-ridding procedure like EBRT or BT.

Source: Defeat Diabetes Foundation: Talcott et al. November 2007. Preprint. American Cancer Society, Cancer Online.

Daniel H. Rasolt writes for Defeat Diabetes® News. Read more of his original content articles.

Copyright © 2008 Defeat Diabetes Foundation, Inc. All rights reserved.