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Relief of Urinary Symptoms Underappreciated Benefit of Early Stage Prostate Cancer Treatment

BIDMC findings presented at American Urological Association Annual Meeting

BOSTON - Treatment of early stage prostate cancer can also result in improved quality of life for a subgroup of men who suffer from lower urinary tract symptoms (LUTS), according to an abstract of a Beth Israel Deaconess Medical Center-led study presented to the American Urological Association.

LUTS, which includes problems of frequent or urgent urination, particularly at night, is a common problem that affects approximately 40 percent of men, a percentage that rises with age. It is not a reason to suspect prostate cancer.

"Possible benefits of prostate cancer treatment in alleviating lower urinary tract symptoms have been largely overlooked," says Martin G. Sanda, MD, Director of the Prostate Center at Beth Israel Deaconess Medical Center and Professor of Urology at Harvard Medical School. "We sought to identify pretreatment determinants of urinary function benefit versus worsening due to prostate cancer treatment."

Researchers prospectively evaluated 1,812 men who underwent prostate removal surgery, radiation therapy and brachytherapy or the implant of radioactive "seeds " across the United States and in Spain. They found use of urinary medications was reduced two years after radical prostatectomy surgery compared to pretreatment, while it was unchanged after radiation and became worse after brachytherapy.

Overall bother from urinary treatment (reflecting combined effects of obstruction or incontinence) was unchanged from pretreatment in 86 percent of the men, improved in 7 percent of the cases and worsened in 7 percent.

"The burden of obstructive lower urinary tract symptoms, which is present in one-third of early stage prostate cancer patients, is underappreciated and deserving of greater emphasis in prostate cancer care decisions," says Sanda. "Contrary to conventional assumptions, the number of men whose health-related quality of life is benefited by early stage prostate cancer treatment is similar to the number who quality of life is adversely impacted. Men with lower urinary tract symptoms may be particularly likely to have a better quality of life benefit from radical prostatectomy."

Coauthors of the study included investigators from the PROSTQA Consortium, funded by the National Cancer Institute, and a team of collaborators from Spain.

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.