Health‐related quality of life in active surveillance and radical prostatectomy for low‐risk prostate cancer: a prospective observational study (HAROW ‐ Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting)

Winter, Nicola; Ernstmann, Nicole; Heidenreich, Axel; Weißbach, L.; Herden, Jan

doi:10.1111/bju.14215

Cited by 16 publications

(17 citation statements)

References 47 publications

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“…Secondly, model 2 indicates that patients who receive RPE or RPE plus adjuvant radiotherapy are more likely to utilize POS than AS/WW patients or those receiving primary radiotherapy after inclusion in the study. This might be related to the often‐mentioned adverse effects of RPE, which in comparison with radiotherapy and active monitoring can severely impede sexual function and urinary continence 23,24 . This may also indicate differences between the in‐patient and outpatient settings and may suggest deficiencies in the organization of care 25 – that is, patients who receive RPE may have better access to POS than patients with primary radiotherapy or those who are undergoing AS/WW.…”

Section: Discussionmentioning

confidence: 99%

“…This might be related to the often-mentioned adverse effects of RPE, which in comparison with radiotherapy and active monitoring can severely impede sexual function and urinary continence. 23,24 This may also indicate differences between the in-patient and outpatient settings and may suggest deficiencies in the organization of care 25 -that is, patients who receive RPE may have better access to POS than patients with primary radiotherapy or those who are undergoing AS/WW. Further research is needed here.…”

Section: Discussionmentioning

confidence: 99%

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Use of psycho‐oncological services by prostate cancer patients: A multilevel analysis

et al. 2020

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Background Cancer patients often suffer from psychological distress. Psycho‐oncological services (POS) have been established in some health care systems in order to address such issues. This study aims to identify patient and center characteristics that elucidate the use of POS by patients in prostate cancer centers (PCCs). Methods Center‐reported certification and patient survey data from 3094 patients in 44 certified PCCs in Germany were gathered in the observational study (Prostate Cancer Outcomes). A multilevel analysis was conducted. Results Model 1 showed that utilization of POS in PCCs is associated with patients’ age (OR = 0.98; 95%‐CI = 0.96‐0.99; P < .001), number of comorbidities (1‐2 vs 0, OR = 1.27; 95%‐CI = 1.00‐1.60; P=.048), disease staging (localized high‐risk vs localized intermediate risk, OR = 1.41; 95%‐CI = 1.14‐1.74; P < .001), receiving androgen deprivation therapy before study inclusion (OR = 0.19; 95%‐CI = 0.10‐0.34; P < .001), and hospital teaching status (university vs academic, OR = 0.09; 95%‐CI = 0.02‐0.55; P = .009). Model 2 additionally includes information on treatment after study inclusion and shows that after inclusion, patients who receive primary radiotherapy (OR = 0.05; 95%‐CI = 0.03‐0.10; P < .001) or undergo active surveillance/watchful waiting (OR = 0.06; 95%‐CI = 0.02‐0.15; P < .001) are less likely to utilize POS than patients who undergo radical prostatectomy. Disease staging (localized high‐risk vs localized intermediate risk, OR = 1.31; 95%‐CI = 1.05‐1.62; P = .02) and teaching status (university vs academic, OR = 0.08; 95%‐CI = 0.01‐0.65; P = .02) are also significant predictors for POS use. The second model did not identify any other significant patient characteristics. Conclusions Future research should explore the role of institutional teaching status and whether associations with therapy after study inclusion are due to treatment effects – for example, less need following radiotherapy – or because access to POS is more difficult for those receiving radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of psycho‐oncological services by prostate cancer patients: A multilevel analysis

et al. 2020

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“… 35 However, their severity and impact on QoL depend on the treatment method used. 40 , 43 , 44 Removing the prostate gland is associated mostly with sexual and urinary dysfunction. 35 Unlike surgery, radiotherapy is associated with bowel dysfunction and, to a lesser extent, with urinary incontinence.…”

Section: Discussionmentioning

confidence: 99%

Quality of Life of Prostate Cancer Patients Undergoing Prostatectomy and Affective Temperament

Popiołek¹,

Brzoszczyk²,

Jarzemski³

et al. 2022

CMAR

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Purpose Prostate cancer (PC) is one of the most common malignancies in men. The population of PC survivors is growing, and understanding the roles of different factors that affect quality of life (QoL) is important. We investigated the effects of affective temperament on the QoL of PC patients. Patients and Methods All subjects (n=100) underwent medical evaluation [including demographic data, medical history, physical examination, biochemical tests, and assessment of urinary incontinence (ICIQ-UI SF scale) and erectile dysfunction (ED) (IIEF-5 and subjective ED scale)] and psychological evaluation [including assessment of affective temperament using the TEMPS-A scale, depression and anxiety (using HADS), and QoL (EORTC-QLQ-C30 and EORTC-PR25)]. The relationships between individual variables were examined. Results Erection quality after treatment was associated with better QoL in most parameters. Similar strong relationships were observed between the urinary incontinence scale and QoL. Depressive, cyclothymic, irritable, and anxious temperaments were associated with decreased QoL. On the EORTC-PR25 scale, associations were observed between a depressive temperament and worse sexual function and urinary symptoms, between a cyclothymic temperament and worse urinary symptoms, and between an irritable temperament and worse sexual functioning. Multivariate analysis identified the severity of anxiety and depression symptoms measured by HADS as the most important psychological factors affecting QoL. Conclusion QoL in PC survivors depends on many factors, including age, interval since diagnosis, tumor stage, treatment, complications, and affective temperament profile. Depressive, cyclothymic, irritable, and anxious temperaments were associated with poorer QoL in selected domains, which was not observed for a hyperthymic temperament. The temperament profile of patients was associated with mood and anxiety level, which were important determinants of a poorer QoL.

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“…We resolved discrepancies by consensus or discussion with a third reviewer. We used suggested language 19 to summarize findings and assessed effect size using prespecified thresholds (Appendix C). For overall and prostate cancer mortality and metastases we defined absolute risk differences of <2% as "little to no difference", 2-4.9% as "small"; 5-9.9% as "moderate" and >10% as "large" effects regardless of population, intervention, comparison or length of follow-up.…”

Section: Grading Evidence Certaintymentioning

confidence: 99%

Therapies for Clinically Localized Prostate Cancer

Dahm¹,

Brasure²,

Ester³

et al. 2020

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Objective. To update findings from previous Agency for Healthcare Research and Quality (AHRQ)- and American Urological Association (AUA) funded reviews evaluating therapies for clinically localized prostate cancer (CLPC). Sources. Bibliographic databases (2013–January 2020); ClinicalTrials.gov; systematic reviews Methods. Controlled studies of CLPC treatments with duration ≥5 years for mortality and metastases and ≥1 year for quality of life and harms. One investigator rated risk of bias (RoB), extracted data, and assessed certainty of evidence; a second checked accuracy. We analyzed English-language studies with low or medium RoB. We incorporated findings from randomized controlled trials (RCTs) identified in the prior reviews if new RCTs provided information on the same intervention comparison. Results. We identified 67 eligible references; 17 were unique RCTs. Among clinically rather than prostate specific antigen (PSA) detected CLPC, Watchful Waiting (WW) may increase mortality and metastases versus Radical Prostatectomy (RP) at 20+ years. Urinary and erectile dysfunction were lower with WW versus RP. WW’s effect on mortality may vary by tumor risk and age but not by race, health status, comorbidities, or PSA. Active Monitoring (AM) probably results in little to no difference in mortality in PSA detected CLPC versus RP or external beam radiation (EBR) plus Androgen Deprivation (AD) regardless of tumor risk. Metastases were slightly higher with AM. Harms were greater with RP than AM and mixed between EBR plus AD versus AM. 3D-conformal EBR and AD plus low-dose-rate brachytherapy (BT) provided a small reduction in all-cause mortality versus three dimensional conformal EBR and AD but little to no difference on metastases. EBR plus AD versus EBR alone may result in a small reduction in mortality and metastases in higher risk disease but may increase sexual harms. EBR plus neoadjuvant AD versus EBR plus concurrent AD may result in little to no difference in mortality and genitourinary toxicity. Conventionally fractionated EBR versus ultrahypofractionated EBR may result in little to no difference in mortality and metastases and urinary and bowel toxicity. Active Surveillance may result in fewer harms than photodynamic therapy and laparoscopic RP may result in more harms than robotic-assisted RP. Little information exists on other treatments. No studies assessed provider or hospital factors of RP comparative effectiveness. Conclusions. RP reduces mortality versus WW in clinically detected CLPC but causes more harms. Effectiveness may be limited to younger men or to those with intermediate risk disease and requires many years to occur. AM results in little to no mortality difference versus RP or EBR plus AD. EBR plus AD reduces mortality versus EBR alone in higher risk CLPC but may worsen sexual function. Adding low-dose-rate BT to 3D-conformal EBR and AD may reduce mortality in higher risk CLPC. RCTs in PSA-detected and MRI staged CLPC are needed.

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Health‐related quality of life in active surveillance and radical prostatectomy for low‐risk prostate cancer: a prospective observational study (HAROW ‐ Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting)

Cited by 16 publications

References 47 publications

Use of psycho‐oncological services by prostate cancer patients: A multilevel analysis

Use of psycho‐oncological services by prostate cancer patients: A multilevel analysis

Quality of Life of Prostate Cancer Patients Undergoing Prostatectomy and Affective Temperament

Therapies for Clinically Localized Prostate Cancer

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