85% of cases of prostate cancer are diagnosed after the age of 65. For localised (i.e. intracapsular) cancer, the treatment options are: prostatectomy, radiotherapy, or waiting and monitoring with no treatment. Despite an unfavourable risk-benefit balance, anti-androgen therapy to counteract male sexual hormones is sometimes offered.

What are the effects of these treatments on the patient’s quality of life? More than 1500 Australians suffering from localised prostate cancer were questioned about their quality of life over 3 years after being diagnosed. Their urinary, sexual and intestinal disorders were assessed and compared to 495 control subjects unaffected by prostate cancer.

The treatments were followed by a significant rise of urinary incontinence, intestinal disorders and sexual impotence, which varied from one treatment to another. Patients given anti-androgen therapy experienced a greater change in their quality of life than those given other treatments.

In practice, when deciding on treatment for localised prostate cancer, it is appropriate to inform patients of the long-term adverse effects of the various options, which can have a significant effect on their quality of life. Refraining from treatment but monitoring is sometimes a reasonable option, especially for patients aged over 75 or for some patients with a well-differentiated tumour.

©Prescrire 1 March 2011

"Informing patients of the long-term effects of treatments for localised prostate cancer" Prescrire Int 2011; 20 (114): 78. (Pdf, subscribers only).