 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate Cancer / March 2008NEJM - SE's of Treatment
(I received the full report which stated "seeds seemed to carry a lower risk of several of these side effects.") The New England Journal of Medicine http://nejm.org <http://web.checkm8.com/adam/em/click/96037/cat=mms.nejm.content.abstract;url=htt ps://secure.nejm.org/ecom/register/promo/reg_022004a.aspx?promo=ONJFBRG2> *Quality of Life and Satisfaction with Outcome among Prostate-Cancer Survivors* / Martin G. Sanda, M.D., Rodney L. Dunn, M.S., Jeff Michalski, M.D., Howard M. Sandler, M.D., Laurel Northouse, R.N., Ph.D., Larry Hembroff, Ph.D., Xihong Lin, Ph.D., Thomas K. Greenfield, Ph.D., Mark S. Litwin, M.D., M.P.H., Christopher S. Saigal, M.D., M.P.H., Arul Mahadevan, M.D., Eric Klein, M.D., Adam Kibel, M.D., Louis L. Pisters, M.D., Deborah Kuban, M.D., Irving Kaplan, M.D., David Wood, M.D., Jay Ciezki, M.D., Nikhil Shah, D.O., and John T. Wei, M.D. / This Article *ABSTRACT* /Background/ We sought to identify determinants of health-related^ quality of life after primary treatment of prostate cancer and to measure the effects of such determinants on satisfaction with the outcome of treatment in patients and their spouses or partners. /Methods/ We prospectively measured outcomes reported by 1201 patients and 625 spouses or partners at multiple centers before and after radical prostatectomy, brachytherapy, or external-beam radiotherapy. We evaluated factors that were associated with changes in quality of life within study groups and determined the effects on satisfaction with the treatment outcome. /Results/ Adjuvant hormone therapy was associated with worse outcomes across multiple quality-of-life domains among patients receiving brachytherapy or radiotherapy. Patients in the brachytherapy group reported having long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function. Adverse effects of prostatectomy on sexual function were mitigated by nerve-sparing procedures. After prostatectomy, urinary incontinence was observed, but urinary irritation and obstruction improved, particularly in patients with large prostates. No treatment-related deaths occurred; serious adverse events were rare. Treatment-related symptoms were exacerbated by obesity, a large prostate size, a high prostate-specific antigen score, and older age. Black patients reported lower satisfaction with the degree of overall treatment outcomes. Changes in quality of life were significantly associated with the degree of outcome satisfaction among patients and their spouses or partners. /Conclusions/ Each prostate-cancer treatment was associated with a distinct pattern of change in quality-of-life domains related to urinary, sexual, bowel, and hormonal function. These changes influenced satisfaction with treatment outcomes among patients and their spouses or partners. ___ Blue Wave/QWK v2.12 On Mar 19, 9:00 pm, califch...@fidotel.com (Califchief) wrote...snip... > (I received the full report which stated "seeds seemed to > carry a lower risk of several of these side effects.") Chief...What was the median time post-treatment that these comments were based on?..ron Ron, This is another one of those irrelevant studies that was followed up for about one year. Not near long enough to have any meaningful results but published for some unknown reason. Obviously RP patients take longer for nerve regeneration and better outcomes and radiation patients outcomes worse off with time usually up to three years post treatment. Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html > Ron, > > This is another one of those irrelevant studies that was followed up for > about one year. Not near long enough to have any meaningful results but > published for some unknown reason. Actually, Ron-Judas, the follow-up was two full years post-treatment. Long enough to draw meaningful conclusions. For some "unknown reason" you have again opened your big mouth before you've read and understood the article. On Mar 20, 2:59 pm, safire <saf...@tele-net.com> wrote...snip... > Actually, Ron-Judas, the follow-up was two full years post-treatment. > Long enough to draw meaningful conclusions. For some "unknown reason" > you have again opened your big mouth before you've read and understood > the article. Safire...Previous work has shown that 2 years is not enough time to draw meaningful conclusions. Significant QOL changes can occur in the 2-6 year post-treatment timeframe, especially for XBRT and BT patients. See for example: J Clin Oncol. 2005 Apr 20;23(12):2772-80; Long-Term Outcomes Among Localized Prostate Cancer Survivors: Health-Related Quality-of-Life Changes After Radical Prostatectomy, External Radiation, and Brachytherapy; Miller DC, Sanda MG, Dunn RL, Montie JE, Pimentel H, Sandler HM, McLaughlin WP, Wei JT. ...ron Hi Ron, The chart they use to report the results is for one year after treatment of prostate cancer. Limitations to the study included lack of randomization to treatment and short duration of follow-up. The RP group included those that did not have nerve sparing surgery of which the adverse side effects would be mitigated by sparing of the nerves. Table. Symptoms Considered by Patients to Be a "Moderate or Big Problem" 1 Year After Treatment of Prostate Cancer Symptoms Prostatectomy Radiotherapy Brachytherapy Sexual function (%) 50 31 30 Urinary incontinence (%) 8 4 5 Urinary irritation or obstruction (%) 12 14 18 Bowel or rectal function (%) 2 11 10 Vitality or hormonal function (%) 9 18 15 In an interview with Medscape Oncology, Dr. Sanda said that 1 important finding from this study is that urinary obstruction was improved by surgery. This is "something that has been largely ignored up to now," he commented, perhaps because other studies have not measured a pretreatment baseline. Urinary obstruction does not affect many men (perhaps approximately only 10%), but most of those who underwent prostatectomy reported an improvement in these symptoms after surgery, he said. One factor found to have a large impact on the outcome was the size of the prostate gland, and this is related to urinary obstruction, he continued. A larger prostate gland, when not removed surgically, tended to lead to more problems with urinary obstruction, so "this is a consideration to bear in mind." The size of the prostate gland is something to "bring up on the table for discussion," he added, as generally smaller prostate sizes are associated with better outcomes. "Doctors have done a good job of stratifying patients by age, but the same has not been done so far for prostate size, and it should be," he said. Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html Hi Ron, The chart they use to report the results is for one year after treatment of prostate cancer. Limitations to the study included lack of randomization to treatment and short duration of follow-up. The RP group included those that did not have nerve sparing surgery of which the adverse side effects would be mitigated by sparing of the nerves. Table. Symptoms Considered by Patients to Be a "Moderate or Big Problem" 1 Year After Treatment of Prostate Cancer Symptoms Prostatectomy Radiotherapy Brachytherapy Sexual function (%) 50 31 30 Urinary incontinence (%) 8 4 5 Urinary irritation or obstruction (%) 12 14 18 Bowel or rectal function (%) 2 11 10 Vitality or hormonal function (%) 9 18 15 In an interview with Medscape Oncology, Dr. Sanda said that 1 important finding from this study is that urinary obstruction was improved by surgery. This is "something that has been largely ignored up to now," he commented, perhaps because other studies have not measured a pretreatment baseline. Urinary obstruction does not affect many men (perhaps approximately only 10%), but most of those who underwent prostatectomy reported an improvement in these symptoms after surgery, he said. One factor found to have a large impact on the outcome was the size of the prostate gland, and this is related to urinary obstruction, he continued. A larger prostate gland, when not removed surgically, tended to lead to more problems with urinary obstruction, so "this is a consideration to bear in mind." The size of the prostate gland is something to "bring up on the table for discussion," he added, as generally smaller prostate sizes are associated with better outcomes. "Doctors have done a good job of stratifying patients by age, but the same has not been done so far for prostate size, and it should be," he said. Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html Ron, If I read your question to Calchief correctly,you ask what the MEDIAN follow-up time was and not total time of follow-up. If total follow-up was two years then MEDIAN follow-up would be about one year as I stated in my response. Follow-up couldn't have been any longer as the study covered 2003 to 2006. Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html > Ron, > If total follow-up was > two years then MEDIAN follow-up would be about one year as I stated in my > response. > > Ron S. The entire group of 1200 + 625 people has been followed for two full years. The concept of "medion" is irrelevant in this context. Do you know what "median" means? |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.