Original article
Clinical–prostate
Health-related quality of life for men with prostate cancer—an evaluation of outcomes 12–24 months after treatment

https://doi.org/10.1016/j.urolonc.2012.04.008Get rights and content

Abstract

Objective

To determine the health-related quality of life (HRQoL) impact of prostate cancer interventions at 2 years post-treatment, and between the 12- and 24-month interval, to better characterize this measure.

Materials and methods

Patients treated at the Center for Prostate Disease Research between June 2003 and February 2010 were offered enrollment into a HRQoL study that entailed a baseline evaluation before prostate biopsy and at 3, 6, 9, 12, 18, 24, and 30 months thereafter. The instruments used were the Expanded Prostate Cancer Index Composite (EPIC), EPIC Demographic, and Medical Outcomes Study Short-Form 36 (SF-36). A Student's t-test and ANOVA were used to examine the association between HRQoL scores, patient demographic, and disease features. Multivariable regression models were used to analyze change over time. Estimates of risk, corresponding confidence intervals, and P values are presented for these longitudinal findings.

Results

The study group was comprised of 595 patients. African Americans (AA) had slightly lower baseline raw scores in all EPIC and SF-36 HRQoL domains, but on bivariate analysis, there was no statistical difference in change of scores over time. Radical prostatectomy (RP) led to the greatest decline in urinary function. Bowel function significantly worsened with the addition of hormone therapy (HT) to external beam radiation therapy (EBRT). Sexual bother and function had a marked decline in all active treatment options. Despite these changes, there were no differences in overall satisfaction. SF-36 domains were not affected by RP, whereas EBRT and EBRT + HT had universal impact. For the 12- to 24-month interval, specifically, patients who underwent EBRT fared worse over this time period, showing continued worsening of urinary bother, hormonal function, physical role, physical component summary, and overall satisfaction. Patients who underwent RP did not show any further decline in the 12- to 24-month interval, but instead showed improvement.

Conclusions

Because of the protracted nature of recovery after surgery, delayed onset of effects from radiation, potential interval decline secondary to age-related symptoms, and longevity of patients with prostate cancer, determination of long-term HRQoL outcomes is integral. Counseling with regard to these outcomes should be balanced with oncologic expectations from 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

References (10)

There are more references available in the full text version of this article.

Cited by (22)

  • Survival and Complications Following Surgery and Radiation for Localized Prostate Cancer: An International Collaborative Review

    2018, European Urology
    Citation Excerpt :

    However, comparing treatment with ADT to no ADT, a recent meta-analysis of randomized trials showed no increase in the risk of cardiovascular death [72]. Adjuvant ADT may potentiate the bowel and sexual toxicity of radiotherapy (either EBRT or brachytherapy) [40,73] and the urinary and sexual toxicity following radical prostatectomy [74]. Furthermore, adjuvant ADT has been associated with significant impairments in HRQoL [40].

  • A prospective study of health-related quality-of-life outcomes for patients with low-risk prostate cancer managed by active surveillance or radiation therapy

    2017, Urologic Oncology: Seminars and Original Investigations
    Citation Excerpt :

    Studies demonstrating the safety of long-term AS have resulted in its increased use for patients with low-risk PCa [4,7–13], from 21% to 32% from 2004 to 2010 [14]. Mounting data support the safety of AS [15–17]. However, data are lacking on the effect of AS on HRQoL parameters.

  • Impact of Age on Quality-of-life Outcomes After Treatment for Localized Prostate Cancer

    2015, European Urology
    Citation Excerpt :

    However, men who were excluded from evaluation because of a lack of complete data had a similar mean age to our study population, differing only by the proportion of CAPRA ≥6 (14% vs 10%), race (76% vs 90% Caucasian ethnicity), and treatment type (56% vs 44% RP; all p < 0.01). Given that CAPRA risk and race are rarely be associated with risk of QOL declines, and that the mean age of the groups was similar, we feel that our analysis is representative of the larger cohort [26]. Our analysis used cutpoints to define categorical age groups.

View all citing articles on Scopus
View full text