The online version of this article (doi:10.1186/s12894-015-0025-6) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
NE made substantial contributions to the design of the analysis, to the statistical analysis and interpretation, and to drafting the manuscript. SN made substantial contributions to drafting the manuscript and to revising it critically for important intellectual content. MS contributed to the statistical analysis and to drafting the manuscript. AK made substantial contributions to drafting the manuscript and to revising it critically for important intellectual content. VR planned the study and was involved in data acquisition and revised the manuscript for important intellectual content. AW contributed to the planning of the analysis, to the statistical analysis, interpretation of results, and drafting the manuscript. All authors gave final approval of the final manuscript.
This study describes and compares health-related quality of life (HRQOL) of prostate cancer patients who received either radical prostatectomy (nerve-sparing, nsRP, or non-nerve-sparing, nnsRP) or radiotherapy (external RT, brachytherapy, or both combined) for treatment of localised prostate cancer.
The prospective, multicenter cohort study included 529 patients. Questionnaires included the IIEF, QLQ-C30, and PORPUS-P. Data were collected before (baseline), three, six, twelve, and twenty-four months after treatment. Differences between groups’ baseline characteristics were assessed; changes over time were analysed with generalised estimating equations (GEE). Missing values were treated with multiple imputation. Further, scores at baseline and end of follow-up were compared to German reference data.
The typical time trend was a decrease of average HRQOL three months after treatment followed by (partial) recovery. RP patients experienced considerable impairment in sexual functioning. The covariate-adjusted GEE identified a significant - but not clinically relevant - treatment effect for diarrhoea (b = 7.0 for RT, p = 0.006) and PORPUS-P (b = 2.3 for nsRP, b = 2.2 for RT, p = 0.045) compared to the reference nnsRP. Most of the HRQOL scores were comparable to German norm values.
Findings from previous research were reproduced in a specific setting of a patient cohort in the German health care system. According to the principle of evidence-based medicine, this strengthens the messages regarding treatment in prostate cancer and its impacts on patients’ health-related quality of life. After adjustment for baseline HRQOL and other covariates, RT patients reported increased symptoms of diarrhoea, and nnsRP patients decreased prostate-specific HRQOL. RP patients experienced considerable impairment in sexual functioning. These differences should be taken into account by physicians when choosing the best therapy for a patient.
Additional file 1: Sexual functioning Radiotherapy Subgroups.tiff. Sexual functioning in the radiotherapy subgroups. Mean scores of brachytherapy, external radiotherapy, and combined radiotherapy cancer patients at baseline and during the 24-month follow-up period after multiple imputation of missing values (circle: brachyRT, triangle: externRT, cross: combRT).12894_2015_25_MOESM1_ESM.tiff
Additional file 2: QLQ-C30 Radiotherapy Subgroups.tiff. Health-related quality of life in the radiotherapy subgroups. Mean scores of brachytherapy, external radiotherapy, and combined radiotherapy cancer patients at baseline and during the 24-month follow-up period after multiple imputation of missing values (circle: brachyRT, triangle: externRT, cross: combRT).12894_2015_25_MOESM2_ESM.tiff
Additional file 3: PorpusP Radiotherapy Subgroups.tiff. PORPUS-P in the radiotherapy subgroups. Mean scores of brachytherapy, external radiotherapy, and combined radiotherapy cancer patients at baseline and during the 24-month follow-up period after multiple imputation of missing values (circle: brachyRT, triangle: externRT, cross: combRT).12894_2015_25_MOESM3_ESM.tiff
Starker A, Saß A. Participation in cancer screening in Germany. Results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt. 2013;56(5–6):858–67. CrossRef
Robert Koch-Institute, Association of population-based cancer registries in Germany. Cancer in Germany 2009/2010. 9th edition. Robert Koch Institute (ed.) and the Association of Population-based Cancer Registries in Germany (ed.). . Incidence and Trends. Berlin, 2014. ( http://www.rki.de/Krebs/EN/Home/homepage_node.html)
Litwin MS, Flanders SC, Pasta DJ, Stoddard ML, Lubeck DP, Henning JM. Sexual function and bother after radical prostatectomy or radiation for prostate cancer: multivariate quality-of-life analysis from CaPSURE. Cancer Prostate Strategic Urol Res Endeavor Urol. 1999;54(3):503–8.
Wittekind C, Meyer H-J, Bootz F. TNM Klassifikation maligner Tumoren, vol. 6. Berlin Heidelberg New York: Springer; 2002.
Fayers P, Aaronson N, Bjordal K, Groenvold M, Curran D, Bottomley A, et al. The EORTC QLQ-C30 scoring manual. 3rd ed. Brussels: European Organization for Research and Treatment of Cancer; 2001.
Osoba D, Rodrigues G, Myles J, Zee B, Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16(1):139–44. PubMed
R Development Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2013.
Schafer J. Analysis of Incomplete Multivariate Data. London: Chapman & Hall; 1997. CrossRef
Miwa S, Mizokami A, Konaka H, Ueno S, Kitagawa Y, Koh E, et al. Prospective longitudinal comparative study of health-related quality of life and treatment satisfaction in patients treated with hormone therapy, radical retropubic prostatectomy, and high or low dose rate brachytherapy for prostate cancer. Rrostate Int. 2013;1(3):117–24. CrossRef
Hashine K, Kusuhara Y, Miura N, Shirato A, Sumiyoshi Y, Kataoka M. A prospective longitudinal study comparing a radical retropubic prostatectomy and permanent prostate brachytherapy regarding the health-related quality of life for localized prostate cancer. Jpn J Clin Oncol. 2008;38(7):480–5. CrossRefPubMed
Noldus J, Michl U, Graefen M, Haese A, Hammerer P, Fernandez S, et al. Die nerverhaltende radikale retropubische Prostatektomie. Ergebnisse nach Patientenbefragung. [Nerve-sparing radical retropubic prostatectomy. Results of a patient survey]. Urol A. 2001;40(2):102–6. CrossRef
Waldmann A, Rohde V, Bremner K, Krahn M, Kuechler T, Katalinic A. Measuring prostate-specific quality of life in prostate cancer patients scheduled for radiotherapy or radical prostatectomy and reference men in Germany and Canada using the Patient Oriented Prostate Utility Scale-Psychometric (PORPUS-P). BMC Cancer. 2009;9:295. CrossRefPubMedPubMedCentral
Ferrer M, Suarez JF, Guedea F, Fernandez P, Macias V, Marino A, et al. Health-related quality of life 2 years after treatment with radical prostatectomy, prostate brachytherapy, or external beam radiotherapy in patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008;72(2):421–32. CrossRefPubMed
Katz A, Ferrer M, Suarez JF, Multicentric Spanish Group of Clinically Localized Prostate C. Comparison of quality of life after stereotactic body radiotherapy and surgery for early-stage prostate cancer. Radiat Oncol (London, England. 2012;7:194. CrossRef
- The ProCaSP study: quality of life outcomes of prostate cancer patients after radiotherapy or radical prostatectomy in a cohort study
- BioMed Central
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