Chen RC et al. (2008) Treatment 'mismatch' in early prostate cancer: do treatment choices take patient quality of life into account? Cancer 112: 61–68

The three most common treatments for prostate cancer are similarly effective but have distinct adverse-effect profiles. External radiation can cause bowel dysfunction, brachytherapy urinary problems, and surgery sexual dysfunction due to nerve damage; each treatment is contraindicated for patients with pre-existing deficits in these areas. Therapy that either does not alleviate or worsens pre-existing symptoms, has harmful adverse effects or reduces a patient's quality of life, is deemed mismatched to the patient. Pre-existing disorders should, therefore, be discussed in detail before therapy is selected.

Chen et al. prospectively assessed the rate of treatment mismatch in 438 patients treated for early prostate cancer at four Boston medical centers over a 6-year period. Participants completed questionnaires on demographic characteristics and urinary, bowel and sexual dysfunction at baseline, and 3, 12, 24 and 36 months after they entered the study, to monitor changes in symptoms. Of the patients enrolled, 389 (89%) reported baseline dysfunction. More than one-third received mismatched treatments that worsened bowel and urinary symptoms or showed no benefit for lost sexual function. Unexpectedly, increased symptom complexity at baseline, which narrows the choice of appropriate treatment options, did not lead to a significant increase in treatment mismatch.

The authors theorize that poor communication between patients and physicians when discussing intimate symptoms prevents an adequate assessment of pretreatment dysfunction. They suggest that patients might be more willing to reveal dysfunction in questionnaires filled in before consultation, which would reduce the risk of mismatch.