A new study shows how important it is for men to carefully consider treatments for early stage prostate cancer.
Fifteen years after surgery or radiation, nearly all of the older men in the study had some problems having sex. And about one-fifth had bladder or bowel trouble, the researchers found.
The study didn't compare the men — who were 70 to 89 years old at the study's end — to others who did not treat their cancer or to older men without the disease. At least one study has suggested that half the healthy men in that age group have sexual problems.
The study isn't a rigorous test of surgery and radiation, but it is the longest follow-up of some men who chose the treatments.
Since early prostate cancers usually aren't fatal but there are no good ways to tell which ones really need treatment, men must be realistic about the side effects they might suffer, said one leader of the study, Dr. David Penson of Vanderbilt University.
"They need to look at these findings and say, 'Oh, my gosh, no matter what I choose, I'm going to have some quality-of-life effect, and it's probably greater than my doctor is telling me.'"
The report is in today's New England Journal of Medicine.
Prostate cancer is the most common cancer in U.S. men. Radiation or surgery to remove the prostate are common treatments when the disease is confined to the gland.
Men usually live a long time after treatment — 14 years on average — so it's important to see how they fare, said another leader of the study, Vanderbilt's Dr. Matthew Resnick.
The study involved 1,655 men diagnosed in 1994 or 1995, when they were 55 to 74. About two-thirds had surgery and the rest had radiation. They were surveyed two, five and 15 years later. By then, 569 of them had died.
Men who underwent surgery had more problems in the first few years after treatment than those given radiation, but by the end of the study, there was no big difference.
After 15 years, 18 percent of the surgery group and 9 percent of the radiation group reported urinary incontinence, and 5percent of the surgery group and 16percent of the radiation group said they were bothered by bowel problems.
But the differences could have occurred by chance, once researchers took into account other factors such as the men's age and tumor size.
Impotence was "near universal" at 15 years, the authors write — 94 percent of the radiation group and 87 percent of the surgery group. But the difference between the groups also was considered possibly due to chance.
The National Cancer Institute paid for the study.