Younger men more bothered after prostate cancer treatment

After treatment for localized prostate cancer, changes in quality of life will vary by age, as will men’s reactions to those changes, according to a new study.

“While older and younger men start with different baseline quality of life function, older men may be less bothered by certain declines that may affect younger patients more,” Dr. Lindsay Hampson told Reuters Health in an email.

Prostate cancer is the most common malignancy in men of all ages in the U.S. Almost 60 percent of new cases are diagnosed in men over the age of 65, and the average age is 66.

Older men are often diagnosed with more aggressive disease and are less likely to get treatment, in part because they worry about the impact on their sexual and urinary function, Hampson and her colleagues write in European Urology.

Determining quality of life priorities is vital to ensuring that patients make well-informed treatment decisions, said Hampson, a urologist at the University of California San Francisco.

The researchers reviewed national data on 5,362 men diagnosed between 1999 and 2013 with aggressive prostate cancer that had not spread. The men received various treatments, including surgery, brachytherapy, external beam radiation, or androgen deprivation, or active surveillance.

Before treatment, and again within two years later, the men filled out surveys that included quality of life questions about their urological functioning and symptoms.

Overall, men over 70 had worse quality of life after treatment than those under 60 – except in terms of mental health - but the younger men were more bothered by quality of life declines.

For sexual function, 40 percent of the younger men reported a decline after treatment, compared to 46 percent of the older men. But 39 percent of younger men reported worsening sexual “bother” versus just 17 percent of the older men.

More men under 60 had declines in urinary function, with 14 percent reporting some negative change, compared to 9 percent of older men.

It’s likely that older men start out with a lower level of function, and lower expectations, and therefore are less bothered by declines, the study team writes. Or, perhaps older men have just learned to cope better with fluctuations in their functioning, they note.

Hampson said quality of life is a very important consideration when contemplating treatment for prostate cancer, and physicians can help patients make appropriate decisions.

“The first critical question is whether the cancer needs treatment because many prostate cancers can be safely followed with active surveillance,” she said.

“Treatment should not be deferred for older men just because of quality of life concerns, just as younger men also need to be counseled about potential changes in quality of life after treatment,” Hampson said.

Sexual and urinary problems are the most common problems after prostate cancer treatment, said Katrina Balter, a researcher at Karolinska Institute in Stockholm, Sweden, who was not involved in the study.

“It is important to discuss potential side effects associated with different treatment options,” Balter said. “If a man is sexually active, he might prioritize treatments with less risk of side effects or go for 'watchful waiting' (i.e. no treatment) whereas others may prioritize local treatment and potentially improved survival,” she told Reuters Health by email.