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.

Prediction of Erectile Function Following Treatment for Prostate Cancer

“…9,20,21 The CaPSURE cohort reported higher pretreatment and posttreatment erectile dysfunction (42% [95% CI, 40%–44%] and 78% [95% CI, 76%–80%] of men, respectively).…”

“…Treatment refinements, such as nerve-sparing techniques, can mitigate erectile dysfunction consequences of prostate cancer treatment, while other treatment variations, such as use of neoadjuvant hormone therapy, 9 can adversely affect sexual outcome. Although associations of these and other factors with patient-reported sexual outcome have been studied, 3,10–13 information regarding how the combination of pretreatment patient characteristics and treatment factors relate to individualized sexual outcome remains limited.…”

The impact of body mass index on treatment outcomes for patients with low-intermediate risk prostate cancer

“…Several studies have shown increased genitourinary and gastrointestinal toxicity from additional RT after RP [ 22 , 24 – 26 ]. In the South West Oncology Group trial, adverse events were more likely to occur in the RP + RT arm compared with the RP arm (23.8 % vs 11.9 %), including urethral strictures (17.8 % vs 9.5 %), total urinary incontinence (6.5 % vs 2.8 %), and rectal complications (3.3 % vs 0 %), respectively [ 25 ].…”

Burden of focal cryoablation versus brachytherapy versus active surveillance in the treatment of very low-risk prostate cancer: a preliminary head-to-head comprehensive assessment

“…Considering that HRQoL in men with localised prostate cancer tend to deteriorate within the first 12 months after diagnosis and that urinary and sexual functions recovery generally occurs within 2 years after virtually all treatments (Huang et al 2010), patients with ≤12 or ≥24 months of follow-up were excluded of this study for homogeneity. The same occurred for those under major life events and morbidity, disease progression/recurrence or under multimodal therapy (Wu et al 2008).…”