Experts say treatment for prostate cancer can lead to serious side effects, including impotence as well as urinary and bowel problems. But how a man's quality of life is affected is not well understood.

In the journal Cancer (Vol. 94: 862-871), Constance Bacon, ScD, and colleagues from the Harvard School of Public Health, shed some light on this issue.

Bacon found that men who decide to get treatment, as well as their doctors, need to be aware that the side effects of treatment — when they occur — are often more than just a minor bother. They can end up affecting almost all aspects of life.

The researchers looked at 783 men treated for early stage prostate cancer between 1993 and 1998, and 1,928 healthy men. The men were asked about possible treatment side effects and about how bothersome these side effects were.

Most of the men who received treatment had either surgery or some type of radiation therapy. Not surprisingly, the study authors found that the men who had treatment experienced more physical side effects than the healthy men. They also had a slightly lower overall quality of life.

Emotional and social aspects of life were especially hard-hit, as were relationships with spouses or life partners.

The researchers then tried to determine the specific causes of the lowered quality of life.

Sexual side effects such as impotence were strongly linked to declines in all areas of quality of life, especially with regard to physical functioning. The declines were seen more in men who had at least some sexual function before treatment.

Urinary problems also affected all aspects of quality of life, but to a lesser degree than sexual problems.

Changes in bowel function, problems that are more common after radiation therapy than surgery, had the most severe effects on quality of life. Psychological and social functioning were both strongly influenced, and resulting in a great deal of distress.

All men faced with a diagnosis of prostate cancer have a difficult choice to make about treatment.

Most often, if the cancer has not spread outside of the prostate gland, surgery and radiation therapy (either external radiation or internal "seed" therapy) offer the best chance for a cure. But they are not without possible problems. For some older men with cancers that are very slow growing, carefully watching the cancer without treatment may be the best option.

Because mental health is likely to be affected by treatment for prostate cancer, these concerns should be discussed before making a treatment choice. And spotting these concerns early on after treatment can allow men the best chance to deal with them effectively.