Urologic Oncology: Seminars and Original Investigations
Original articleClinical–prostateHealth-related quality of life for men with prostate cancer—an evaluation of outcomes 12–24 months after treatment
Introduction
Assessing impact of treatment on patient satisfaction has long been a concern of physicians. Unfortunately, quantitative measures of these outcomes many times lag behind other clinical parameters. Recently, health-related quality of life (HRQoL) outcomes after prostate cancer (CaP) treatment have taken center stage. As multidisciplinary clinics become the standard of care for comprehensive counseling of newly-diagnosed CaP patients, providers must incorporate HRQoL outcomes into their discussion of available management options. In this way, patients can be made cognizant of not only the oncologic results of each treatment modality, but also their associated health-related side effects. Our goal was to characterize HRQoL outcomes for a variety of treatment choices in patients who had undergone standardized multidisciplinary counseling in an equal-access medical center [1]. We are interested in doing so 12 to 24 months after treatment to more accurately assess long-term function after adequate recovery time has elapsed and psychological impact of newly diagnosed cancer has been minimized.
Section snippets
Study sample
Patients presenting to our institution, an equal-access military medical center, for counseling and management of newly diagnosed CaP between June 2003 and October 2010 were offered enrollment into an institutional review board-approved HRQoL database. Enrollment was offered at the time of primary evaluation to those thought to be at risk for CaP, and who were scheduled for a prostate biopsy. Ninety-five percent of patients offered enrollment accepted. Patients with negative biopsies are
Results
Of the 1,432 patients enrolled, 595 comprised the study group with at least 24 months of follow-up. Table 2A and 2B lists the demographic and clinical characteristics. The patients are notable for 178 (29.9%) being African Americans (AA), 497 (83.8%) being married, 314 (53.4%) attending graduate or professional school, and 292 (50.3%) earning more than $100,000 annually. Median age was 63.1 years and mean PSA was 6.78 ng/dl. A total of 409 (68.7%) patients were clinical T1c, and 418 (70.9%) had
Discussion
HRQoL is a major component in treatment choice for CaP. Accurate assessment of these factors is critical to patient counseling and assisting in this decision-making process. We set out to determine long-term outcomes in HRQoL for a variety of treatment options with consideration of multiple clinical and demographic features. One of the unique components of this study is defining changes in HRQoL over time for the 12- to 24-month interval. Prior studies have reported results at 2 years, but
Conclusions
Several investigators have evaluated short-term HRQoL outcomes following a range of CaP treatments; however, because of the protracted nature of recovery after surgery, delayed onset of effects from radiation, potential interval decline caused by age-related symptoms, and longevity of patients with CaP, more information must be gathered about long-term outcomes. Such data will aid in effective counseling and patient satisfaction with treatment choice as expectations will be more concordant with
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