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Prostate cancer treatment and robotic surgery expert Dr. David Samadi, MD discusses Massachusetts General Hospital Cancer study on radiation side effects.

A study appearing in the Journal of the American Medical Association shows that side effects from radiation therapy for prostate cancer appear to diminish over time.

The study, led by Dr. James Talcott, of the Center for Outcomes Research at the Massachusetts General Hospital (MGH) Cancer Center, followed post-treatment patients during the course of ten years after treatment. Patients did not report an increase in side effects after their radiation levels had been augmented in order to prevent tumor recurrence. The long-term patients in the study described their symptoms as normal."It makes me wonder if the treatment was successful or if the patient just learned to live with the symptoms," mused Dr. David B. Samadi, Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center in New York. The study's author, Dr. Talcott, admitted, "As clinicians, we know that patients adapt to their situation and accept physical changes as the 'new normal.'"

"The 'new normal' does not spell 'success' to me," said Samadi, a robotic prostatectomy and robotic surgery expert who has performed over 2,250 successful cases.

The study was centered on participants' reports of their experiences, considered to be the most precise indicator of side effects. Participants provided assessments of urinary, bowel and sexual symptoms usually affected by prostate cancer treatment. They ranked their function in these specific areas as well as their attitudes regarding their current health, cancer and treatments. Participants had low levels of side effects and quality of life problems. Their overall ranking of these functions was normal; typically better than would have been expected.

Dr. Talcott quoted a patient in his late 60s who experienced impotence a couple of years post-treatment and rationalized that this condition would have eventually afflicted him, given his age. Talcott said that patients could expect that treatment side effects would probably "bother them less than they originally fear because they are likely to adjust and experience less distress over time." Talcott also admitted that clinicians may need to revisit their standard measures of treatment outcomes, "which assume that the impact of symptoms on patients' quality of life does not change over time."

"Aside from the pain factor, this impact doesn't seem to apply to other symptoms," said Dr. Samadi, "And this, to me, is not quality care. My goal in treating prostate cancer patients is three-fold: cure, sexual function and continence. I have an excellent record with all three factors. It's never enough for me to only give a patient just one or two out of three factors."

"I would never expect a patient of mine in his late 60s to just give up on sexual function as a casualty of his age," said Dr. Samadi. "This is why I stand behind the da Vinci robotic prostatectomy. Sparing sexual function, along with continence, should always go hand-in-hand with a total cure."

Source: JAMA

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