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Quality of Life Returns to Normal in Year Following Brachytherapy

In the first study of its type, Wake Forest University investigators reported today (May 3) that the quality of life for prostate cancer patients returns to normal within one year after implantation of permanent-source brachytherapy, and symptoms essentially disappear.

In a presentation to the American Urological Society, meeting in Atlanta, the team reported one of the first analyses of quality of life following the implantation of radioactive iodine - one of three treatment options for prostate cancer patients. Bracyhtherapy is the placing of a radioactive source in or near a tumor - in this case the radioactive iodine.

For the first few months after implantation, urinary symptoms persist, but return to normal by the end of the year, the team reported. Quality of life measurements indicate that the quality of life declined for several months but then returned to normal, or even slightly better than normal.

The presentation, by Jeffrey H. Martin, M.D., a fourth-year resident in urology, described the evaluation of 31 prostate cancer patients treated with radioactive iodine.

"This procedure is being marketed as maintaining the quality of life and we need to make sure that it really is," he said.

One of his co-authors, W. Robert Lee, M.D., associate professor of radiation oncology, noted that the two other common methods of treating early-stage prostate cancer - removal of the prostate or standard radiation therapy - carry a high risk of decreased sexual function, continuing urinary symptoms and even bowel problems.

Doctors, aided either by ultrasound or CT scanning, can now implant the radioactive iodine on an outpatient basis.

"The need for this type of evaluation in men with clinically localized prostate cancer is important, given the multiple treatment options available," said Lee. Information about the projected health-related quality of life following each procedure "may help clinicians and patients to make more informed treatment decisions."

The quality-of-life questionnaire used in the study - Functional Assessment of Cancer Therapy-Prostate (FACT-P) - has a number of questions measuring physical, functional, social/family and emotional well-being, satisfaction with the doctor-patient relationship, and urinary, bowel and sexual function. A 10-point decrease "is thought to be a meaningful change," Lee said.

The results that Martin presented showed that the FACT-P dropped from an average of 140.5 to 132.7 in the month after brachytherapy, then gradually increased over the ensuing months until it averaged 142.4 a year later - equal to or better than where the patient started.

Urinary symptoms - as measured on the American Urological Association Symptom Score - jumped from an average of 8.3 to 18.4 a month after brachytherapy, but then declined steadily so that one year later, the symptom score averaged 10.2.

In essence, quality of life deteriorates as symptoms increase.

Importantly, the team gave the quality-of-life questionnaire before brachytherapy. "If you give this quality-of-life questionnaire to men who are 60 and 70, many men will have urinary, bowel and sexual problems, even if they don''t have cancer," said Lee.

So studies that attempt to artificially factor for these symptoms are fraught with difficulty. The Wake Forest team gave the same quality-of-life questionnaire before brachytherapy and then at one month, three months, six months and 12 months, so they had prospective measurements using a validated instrument.

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