Suzanne Somers once remarked, “I appreciate health care that gets to the root cause of our symptoms and promotes wellness, rather than the one-size-fits-all drug-based approach to treating disease. I love maintaining an optimal quality of life – naturally.” Ms. Somers’ words capture what we all want: to stay healthy and preserve vitality of body, mind and spirit with as little intervention as possible. In truth, intervention is sometimes required in order to spare us from worse consequences. The problem is, we can’t always know in advance if intervention will turn into interference with quality of life. Sadly, prostate cancer treatment that is intended to save life often results in diminished quality of life. In turn, that can lead to yet more intervention.
After decades of accepting radical prostatectomy (RP) as a one-size-fits-all treatment of choice for prostate cancer, active surveillance (AS) is gaining ground as a recommended strategy for early stage, low risk prostate cancer patients. Why? Because the side effects of RP damage a man’s natural quality of life—not to mention that of his partner. The appeal of AS lies in the ability to postpone the risk of incontinence and ED for some years. There is also much less risk associated with monitoring during AS, thanks to today’s accuracy of imaging in conjunction with biomarkers that signal possible disease progression.
A newly published paper from a consortium of U.S. medical centers confirms that prostate cancer patients who opt for AS have higher quality of life than RP patients over the same duration.[i] The study cohort consisted of men age 75 or younger who either had RP (228 patients) or AS (77 patients). Using self-report by standardized questionnaires, the men were followed for three years. The authors discovered that “patients in the RP group had significantly worse sexual function, sexual bother, and urinary function at all time points compared with patients in the AS group.” This is no surprise, as the patients on AS maintained natural quality of life.
Another recent study of 374 RP patients confirms that RP has a worse impact on younger patients. The subjects were divided into age groups (age 60 and under; 61-70; and over 70). Quality of life questionnaires were completed a day before surgery, and again at 3, 6, 9 and 12 months. The questionnaires were focused on emotional, cognitive and social quality of life, not urinary and sexual function. The younger patients (<60) fared the worst. I believe it’s because they had more to lose in terms of natural quality of life.
Focal prostate cancer treatment offers a happy medium between the uncertainty of AS and the overkill of cookie-cutter radical treatments for those who don’t require them. Until the development of an effective cancer vaccine or immunotherapy, there will continue to be a need for whole gland treatments (surgery and radiation) because not every patient is diagnosed with focal disease, and because a minority of patients will be diagnosed with a virulent strain of prostate cancer that requires a take-no-prisoner approach to treatment.
For now, both AS and focal therapy offer two roads to preserving natural vitality and quality of life. The Sperling Prostate Center is proud to help prostate cancer patients maintain optimal quality of life through image-guided focal laser ablation (FLA) which has the lowest risk of side effects while destroying the cancer.
[i] Jeldres C, Cullen J, Hurwitz LM, Wolff EM, Levie KE, O Prospective quality-of-life outcomes for low-risk prostate cancer: Active surveillance versus radical prostatectomy. Cancer. 2015 Apr 6. Epub ahead of print. doi: 10.1002/cncr.29370