Health Related Quality of Life in Patients Treated With Multimodal Therapy for Prostate Cancer

Abstract

Purpose: Patients with prostate cancer and high risk disease characteristics may benefit from multimodal therapy. However, the effects of multimodal therapy on health related quality of life have not been comprehensively described. We further characterized health related quality of life in patients treated with multimodal therapy. Materials and Methods: Patient data were obtained from the CaPSURE™ database, a national disease registry of men with prostate cancer. Included patients received active primary therapy (ie surgery or various forms of radiation) for prostate cancer with or without adjuvant or neoadjuvant therapy, and had complete clinical data, including health related quality of life assessments at baseline and through 2 years after treatment. The association between health related quality of life outcomes and different primary therapies with and without adjuvant or neoadjuvant therapy over time was analyzed using a repeated measures mixed model for each primary therapy. Results: A total of 2,204 men met the study criteria. As primary therapy 1,427 patients received radical prostatectomy, 267 received external beam radiation therapy and 510 received brachytherapy. When androgen deprivation therapy was included with radical prostatectomy, brachytherapy or external beam radiation therapy, there was a transient loss of sexual function that improved within 9 months postoperatively. When external beam radiation therapy was given with brachytherapy there was continuous worsening of urinary function and bother through 21 months. Conclusions: Multimodal therapy may lead to declines in health related quality of life especially in the domains of urinary function, urinary bother and sexual function. These effects must be considered and patients must be counseled appropriately before initiation of multimodal therapy.

Perfil epidemiológico e fatores prognósticos no tratamento cirúrgico do adenocarcinoma de próstata clinicamente localizado

“…A extensão anatômica do tumor é o fator de prognóstico mais importante e mais amplamente utilizado. A classificação TNM é aceita internacionalmente para descrever e comparar padrões de apresentação da doença, impacto do rastreamento e acesso ao tratamento, criando linguagem universal e proporcionando padronização na indicação do tratamento 17,18 . O PSA é marcador tecidual, porém não tumor específico.…”

“…Com relação à qualidade de vida pós-operatória os dados encontrados neste trabalho coincidem com os da literatura, onde as taxas de impotência relatadas são discrepantes e altas variando ente 60 a 90% 17,18,32 . Thompson et al observou que homens mais jovens (<60 anos) são mais propensos em manter ereções que homens mais velhos, e que a recuperação sexual ocorre ao longo do primeiro estendendo-se até o 4º ano, fato observado neste estudo, porém sem significância estatística 17 .…”

Impact of androgen deprivation on physical well‐being in patients with prostate cancer

“…33 Although there were differences in magnitude, results from this study suggest that both primary and combination use of ADT is associated with a decline in physical well-being in most patients. Patients undergoing multimodal therapy reported having worse health-related quality of life compared with monotherapy, 21,34 whereas ADT significantly affected physical function compared with active treatments. 10,35,36 Given differences in scores at pretreatment and the lower magnitude of the decline, it is reasonable to suggest that combination therapy influences physical well-being to a smaller degree compared with ADT alone, but nevertheless these effects have to be Original Article…”

“…9 Similarly, health-related quality of life outcomes have been shown to be severely impacted by ADT. 14,[19][20][21][22] However, most studies evaluating effects of ADT on physical well-being have been limited to a small number of participants, have lacked pretreatment information, or have followed patients only to the immediate post-treatment period.…”

Long-term quality of life in disadvantaged men with prostate cancer on androgen-deprivation therapy

“…Furthermore, men not receiving ADT had poorer urinary function compared with men on ADT. Because RPRT directly affect the urinary system, 22,23 it is expected that those who received these procedures more frequently (non-ADT users) would have poorer urinary function than those who received ADT alone. Second, underserved men with prostate cancer are often diagnosed at a later stage and receive ADT as primary treatment.…”