SAN ANTONIOA new study has shown that prostate cancer patients
treated with 3D conformal radiation therapy may not differ from the
normal population in bladder quality-of-life issues. The
bladder findings were very interesting, said Alexandra Hanlon,
PhD. Weve never had a baseline before for urinary
incontinence; that is, we havent known the incidence in the
normal population. We showed in this study that urinary incontinence
is no more common in prostate cancer patients who have had 3D
conformal radiation therapy than in the normal population.
Based on the study results, nocturia may be the greatest symptom of
concern in this group, said Dr. Hanlon, senior research statistician,
Fox Chase Cancer Center. Men report being bothered by having to
get up at night to urinate, but this bother may be related to an
interruption of sleep, as opposed to the urination itself, Dr.
Hanlon said at the American Society for Therapeutic Radiology and
Oncology annual meeting.
Two health status surveys that evaluated bowel and bladder
functioning were mailed to 195 prostate cancer patients who were
treated with 3D conformal radiation therapy at Fox Chase Cancer
Center from 1992 to 1995. Patients also received the AUA Symptom
Problem Index and the BPH Index. The normal population was obtained
from a study by Litwin (J Urol 161:1180-1184, 1999).
Responses were obtained from 139 men, 69 treated to the prostate
and/or seminal vesicles alone and 73 treated to the whole pelvis.
Regarding bowel symptoms, no differences in the two groups were found
in rectal bleeding, abdominal pain, bowel control, or rectal
discomfort. We did, however, observe differences, according to
field size, when we looked at diarrhea frequency, rectal urgency, and
pad usage. And this surfaced in the bowel functioning satisfaction
differences, Dr. Hanlon said. Five percent of the patients
reported the use of pads for bowel incontinence, and all of these
were patients who were treated to the whole pelvis.
Regarding urinary symptoms, no differences were found between the two
groups for urinary incontinence, pad usage, pain, or bleeding, or
with respect to bladder functioning satisfaction. Marginal
differences with respect to the degree of bother and trouble with
urination over the previous month were observed.
Only 2% of the patients reported this as a major problem, and
all of these patients had received treatment to the whole
pelvis, Dr. Hanlon said, adding that this bother was associated
with getting up at night to urinate.
In the second part of the study, the bowel and bladder
quality-of-life issues in these prostate cancer patients were
compared with those of the normal population using the Litwin study
as a control group. No differences were found with respect to rectal
urgency or abdominal pain. We did, however, note differences in
diarrhea and bother from bowel dysfunction. Only 4% of the patients
reported this as a big problem, compared with 1% of the normal
controls, she said.
For the bladder, the Litwin study concentrated on urinary
incontinence. We found no differences whatsoever with respect
to this area, she said.
Two percent of the study patients reported the use of pads to control
urinary leakage, and that was identical to the normal population.
And the percentage of patients reporting total urinary control
was almost identical as well, 71% vs 69% in the control group,
Since nocturia may be problematic in these patients, Dr. Hanlon said
that future research is needed to assess sleep patterns, satisfaction
of sleep, and fatigue in men who have been treated with radiation
therapy for prostate cancer.