A new study in the journal Cancer reveals that some prostate cancer patients who have certain dysfunctions prior to receiving cancer treatment often receive therapy that is contraindicated or "mismatched," leading to worse outcomes.

Clinical studies have shown no differences in efficacy between major therapies for prostate cancer, but each carries certain risk, such as urinary incontinence or sexual dysfunction. These risks mean that treatment planning should take into consideration an individual patient's pretreatment status, says a new study by James Talcott, M.D., of Massachusetts General Hospital in Boston and colleagues. For example, a patient with a pre-existing bowel dysfunction should not receive external beam radiation as the first line of therapy because of inevitable irradiation to the adjacent rectum, which can cause long-term bowel dysfunction. Patients with certain urinary obstructive symptoms should not receive brachytherapy.

In a survey of 438 patients who sought therapy for localized prostate cancer in the Boston area over a six-year period, 389 patients reported after treatment that they had pre-existing dysfunction. More than one-third of those surveyed reported mismatched treatments. The authors said the observations raise concerns about physician-patient communication. The study appears in the November 26, 2007, issue of Cancer.