Quality of Life in Men Treated for Early Prostate Cancer: A Prospective Patient Preference Cohort Study

Carmel Nirupa Anandadas, Susan Elizabeth Davidson, Noel William Clarke, Stephen Charles William Brown, John Paul Logue, Lynne Gilmore, Richard Swindell, Gerald Nicholas Collins, Patrick Henry O’Reilly, Guy David Wemyss-Holden, Maurice Waiming Lau, Pradip Madhukar Javle, Vijay Alini Chandi Ramani, Richard James Brough, James Pinson Wylie, Richard Andrew Cowan

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DOI: 10.4236/jct.2011.24060                

Abstract

Objectives: In 1997, a study was launched to investigate the treatment of early prostate cancer. Using a patient preference design, health-related quality-of-life (HRQOL) and disease specific HRQOL was assessed prospectively to compare men undergoing radical prostatectomy (RP), hypo-fractionated conformal radiotherapy (CRT) or brachytherapy (BT). Methods: Patients with localised prostate cancer were counselled by a urological surgeon, clinical oncologist and specialist uro-oncology nurse. Patients received treatment according to individual preference. 430 men chose and received RP (n = 217), CRT (n = 161) and BT (n = 52). 354 (82%) completed pre-treatment RAND 36-Item Short-Form Health survey version-2 (SF36v2) and University of California, Los Angeles Prostate cancer index (UCLA-PCI) questionnaires. HRQOL score changes from baseline to 24 months were compared using Kruskall-Wallis test. Results: Pre-treatment, the CRT cohort scored lower for physical function (p = 0.0029) and general health perception (p = 0.0021). The BT cohort reported better baseline scores for urinary function (p = 0.0291), urinary bother (p = 0.0030), sexual function (p = 0.0009) and bowel bother (p = 0.0063). At 24 months, bowel function was similar for CRT and BT but both modalities were worse than RP (p = 0.0010). Urinary continence deteriorated most following RP (p < 0.0001) but BT had worse urinary bother (p = 0.0153). Sexual function deteriorated most following RP and BT (p < 0.0005). Percentages of patients achieving erections adequate for sexual activity (from baseline to 24 months) were 66% to 29% for RP, 62% to 49% for CRT and 88% to 65% for BT. Conclusion: This data demonstrates significant differences in disease specific quality-of-life between RP, CRT and BT and should be available for men with early prostate cancer making treatment decisions.

Keywords

Early Prostate Cancer, Quality of Life, Patient Preference, Prostatectomy, Hypo-Fractionated Radiotherapy, Brachytherapy

Conflicts of Interest

The authors declare no conflicts of interest.

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