SAN ANTONIO—A 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. “We’ve never had a baseline before for urinary incontinence; that is, we haven’t 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,” she said.
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.
