information about differences in quality of life outcomes
can help determine the best choice. An example can be
found in treatment for localized prostate cancer, for which
there is continuing controversy regarding whether radical
prostatectomy or radiation therapy provides superior out-
comes in older men.
In an early study comparing quality
of life outcomes for men receiving radical prostatectomy
or radiation therapy, Yarbro and Ferrans found that
those treated by surgery had significantly worse urinary
and sexual functioning. Protective pads or adult diapers
were worn daily by 32% of the men in the surgical group,
as compared with only 6% of the radiation group. Ability
to have an erection was reported to be very poor for 88%
of the surgical group and for only 46% of the radiation
group. In contrast, the radiation group had worse bowel
functioning due to radiation damage to the rectal mucosa,
although the differences between groups were smaller in
this area. Diarrhea and cramping pain were problems for
only a few men. Similar findings later were reported in a
nationwide Prostate Cancer Outcomes Study
as well as in a prospective study.
These studies provide impor-
tant information for older men to consider as they decide
which treatment to pursue for prostate cancer.