Prostate cancer treatment choices influenced by money

The treatment choices men make when diagnosed with prostate cancer can have a significant bearing on subsequent quality of life, including urinary and sexual function, and sometimes those choices are influenced by finances.

An all-island study involving 3,348 prostate cancer survivors, conducted by the National Cancer Registry and the Northern Ireland Cancer Registry, found long-term health-related quality of life was affected by the main course of treatment men chose following a cancer diagnosis.

For instance, men who took the radical option of having their prostate gland removed subsequently had a significantly higher quality of life than men who chose hormone therapy alone or radiotherapy without concurrent hormone therapy.

Quality of life for men who received brachytherapy, where radioactive seeds are planted in or near the tumour, or radiotherapy with simultaneous hormone therapy, or active surveillance/watchful waiting (monitoring to see if symptoms progress) was “not significantly different” from men who had their prostate removed.

Men treated with brachytherapy — sometimes described as the “gold standard treatment” — had highest quality of life scores, while those treated with hormone therapy had the lowest.

Frances Drummond, one of the study’s main authors, said those who underwent radical prostatectomy “were more likely to have financial difficulties” because they were generally younger — removal of prostate was a more frequent option in younger men surveyed — and therefore more likely to be in employment, which would be disrupted by prolonged treatment.

Men who opted for brachytherapy were least affected by financial difficulties, but Dr Drummond said this was likely to reflect the fact that when the survey was carried out, brachytherapy was only available to private patients.

It is now available in the public system, including at Cork University Hospital. The patients in the survey were between two and 18 years post-diagnosis.

The men experienced “significant differences” in general symptoms, depending on the primary treatment they chose.

For instance, those who opted for prostate removal “had clinically worse urinary bother and sexual functioning”, and those treated with radiotherapy with or without hormone therapy “had the worst bowel symptoms, sexual activity, fatigue, pain, and dyspnoea” (breathlessness).

Despite this, survivors’ quality of life was not “statistically or clinically significantly different”, possibly explained by many survivors undergoing a “response shift”, whereby their concept of quality of life changes because they perhaps prioritise survival above symptoms or physical limitations, said Dr Drummond.

The study’s findings showed how important it was for patients to be fully briefed about treatment choices, she said.

“Men should be made aware of all of the details before making a decision on treatment and they should be made aware of the long-term consequences of that treatment,” said Dr Drummond. “That is the message we want to get across.”

The findings of the PiCTure (Prostate Cancer Treatment, your experience) study have been published in the Journal of Cancer Survivorship.