Health Outcomes After Prostatectomy or Radiotherapy for Prostate Cancer: Results From the Prostate Cancer Outcomes Study

We assessed the longitudinal alteration of the quality of life (QOL) of patients with localized prostate cancer after radical prostatectomy or hormonoradiotherapy during 3-y follow-up. In addition, we examined the impact on QOL of initiation of second treatment after failure of primary treatment. In all, 135 patients with localized prostate cancer who underwent radical retropubic prostatectomy (RP) (N ¼ 84) or external beam radiotherapy with neoadjuvant hormone (XRT) (N ¼ 51) at our institute and who had a minimum follow-up of 3 y were included in this study. Data were collected prospectively, at baseline, at 3 months after treatment, at 1 y, and annually thereafter. QOL, generic and disease-targeted was evaluated using the European Organization for Research and Treatment of Cancer Prostate Cancer QOL Questionnaire, the Sapporo Medical University Sexual Function Questionnaire, the International Prostate Symptom Index Quality of Life Score and similar questions regarding bowel function. Repeated-measures ANOVA revealed significantly different patterns of alteration in the domains of QOL, with the exception of several domains, between the RP and XRT groups. Rapid decline of sexual function and increase in sexual bothersomeness were followed by slight amelioration throughout follow-up in the RP group, and did not change thereafter in the XRT group. Overall satisfaction with urinary condition significantly improved after treatment and that with bowel condition was stable during followup in both of the groups. Failure of primary treatment and initiation of salvage treatment had no impact on QOL. This prospective study revealed longitudinal alteration of QOL status of patients undergoing treatment for localized prostate cancer, but did not yield any conclusions regarding effect of treatment failure and second treatment on QOL due to small sample size. It should be noted that different instruments for assessment of QOL can generate different outcomes.

Section: Discussioncontrasting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

A 3-y prospective study of health-related and disease-specific quality of life in patients with nonmetastatic prostate cancer treated with radical prostatectomy or external beam radiotherapy

Yoshimura

Arai

Ichioka

et al. 2004

“…Our result, therefore, supports the role of radical prostatectomy in improving overall and prostate-cancer specific survival. [40][41][42] There are several strengths to the results obtained in this current study. Primarily, the data used in this study was obtained from the NCI's SEER program, which accounts for 14% of the total US population and ascertains nearly all cancer patients in the designated SEER registries.…”

Section: Androgen Deprivation Therapy and Prostate Cancer Survival L mentioning

confidence: 77%

Effectiveness of androgen deprivation therapy in prolonging survival of older men treated for locoregional prostate cancer

Holmes

Chan

Jiang

et al. 2007

Epidemiologic and experimental evidence suggests the effectiveness of androgen deprivation therapy (ADT) in prostate cancer (CaP) management. Although ADT has been increasingly used as mono-therapy in CaP, the survival benefit of ADT remains unclear. We examined the effectiveness of ADT in prolonging survival in a community-based cohort of 64 475 older men diagnosed with locoregional CaP, in 1992-1999 with last follow-up through December 2002, in 11 Surveillance Epidemiology and End Results (SEER) registries. The effect of ADT on survival was assessed using Kaplan-Meier's method, log-rank test and Cox proportional hazards. After adjustment for propensity to receive ADT, the ADT and non-ADT groups were significantly different in the distribution of covariates except for comorbidity score and SEER registries. The crude overall mortality was significantly higher in cases with ADT compared with cases that received no ADT, hazard ratio (HR ¼ 1.54; 95% CI ¼ 1.50-1.58). However, mortality was substantially reduced (1.04, 1.00-1.08) after adjusting for standard care, socio-demographics, tumor characteristics, prognostic factors and chemotherapy. Therefore, ADT was not associated with significantly increased survival benefit for older men with locoregional CaP. Further studies may be needed to explore whether ADT is associated with other health benefits and the cost-effectiveness of these benefits.

“…Furthermore, the great majority of patients receiving treatment for clinically localized prostate cancer ultimately die with, rather than of, their carcinoma. Therefore, the patients will have to live many years with the long-term effects of their treatment, 3 which may have adverse impact on the patients' QoL.…”

Section: Introductionmentioning

confidence: 99%

Prostate-specific symptoms of prostate cancer in a German general population

Bestmann

Loetters²,

Diemer³

et al. 2006

Predominant symptoms in prostate cancer patients are erectile dysfunctions and urinary problems. As decreases of these functions can be attributed to disease and treatment but also to age-related decreases, we conducted a study on a German reference population measuring general quality of life (QoL) as well as prostate-specific symptoms. In cooperation with a German health insurance company, 3000 questionnaires were mailed to a randomly selected sample of men aged 45-75 years. Questionnaires used were the EORTC QLQ-C30 and a prostate-specific module (PSM). One thousand one hundred and fifty questionnaires were returned (response rate: 37.6%). QoL data from this reference population were compared to QoL data from a historical cohort study of prostate cancer patients following either prostatectomy or radiotherapy. In terms of general QoL, the reference population showed similar QoL scores as prostatectomy patients, but better scores than radiotherapy patients. On the PSM, the reference sample showed better overall QoL, but a surprisingly high extent of erectile dysfunction, urinary problems and psychic strain. Taking into account the sensitive topic of this study (sexuality and urinary problems), the response rate is more than satisfying. Older men in our randomly selected, population-based sample do not show perfect erectile and urinary function. These findings should be considered when interpreting QoL data of prostate cancer patients.