Quality of life following treatment for early prostate cancer: does low dose rate (LDR) brachytherapy offer a better outcome? A review.
OBJECTIVE
Due to a lack of evidence from randomised studies, there is little agreement on the best form of treatment among men who require curative treatment for prostate cancer. The relative impact of the various treatments on symptoms and health-related quality of life is also controversial. We review the literature on quality of life changes following low dose rate brachytherapy (BXT) and compare BXT to other treatments for early prostate cancer.


METHODS
Systematic literature review 1988-2003 (Medline).


BACKGROUND
Brachytherapy; Radical prostatectomy; External beam radiotherapy; Quality of life; Symptoms.


RESULTS
Review of the current literature suggests that radical prostatectomy, external beam radiotherapy and BXT either alone or in combination with supplementary external beam radiotherapy offer good long-term health-related quality of life. However differences exist in the toxicity of treatment in terms of erectile function, voiding difficulty, incontinence and bowel function. These differences seem to persist for at least 3-5 years post-treatment though longer-term quality of life outcomes from modern techniques are unknown.


CONCLUSIONS
BXT offers a high probability of maintaining continence, potency and normal rectal function though both storage and voiding urinary symptoms have been reported. Addition of androgen deprivation and EBRT to BXT may increase urinary, bowel and sexual toxicity of treatment. Quality of life outcome following brachytherapy compares favourably with other radical treatment options for the management of early prostate cancer.
Henderson
Alastair
A
Department of Urology, Royal Surrey County Hospital, St. Luke's Cancer Center, Egerton Road, GU2 5XX. Guildford, UK. alihenderson@freenet.co.uk
Laing
Robert W
RW
Langley
Stephen E M
SE
D001918:Brachytherapy / Q000009:adverse effects; D003131:Combined Modality Therapy; D005544:Forecasting; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D013997:Time Factors; D016896:Treatment Outcome