Journal of the National Cancer Institute Advance Access originally published online on June 9, 2009
JNCI Journal of the National Cancer Institute 2009 101(12):888-892; doi:10.1093/jnci/djp114
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© The Author 2009. Published by Oxford University Press.
BRIEF COMMUNICATION |
Survivorship Beyond Convalescence: 48-Month Quality-of-Life Outcomes After Treatment for Localized Prostate Cancer
Affiliations of authors: VA Greater Los Angeles Healthcare System Division of General Internal Medicine, Los Angeles, CA (JLG); UCLA Robert Wood Johnson Clinical Scholars Program, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA Los Angeles, CA (JLG); Jonsson Comprehensive Cancer Center (LK, RER, MSL), Department of Urology (JLG, RER, MSL), and Department of Radiation Oncology (SPL), David Geffen School of Medicine at University of California, Los Angeles, (UCLA), Los Angeles, CA
Correspondence to: John L. Gore, MD, Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, 911 Broxton Ave, 3rd Floor, Los Angeles, CA 90024 (e-mail: jgore{at}mednet.ucla.edu).
Decision making for treatment of localized prostate cancer is often guided by therapeutic side-effect profiles. We sought to assess health-related quality-of-life outcomes for patients 48 months after treatment for localized prostate cancer. Men treated for localized prostate cancer (N = 475) were evaluated before treatment and at 11 intervals during the 48 months after intervention. Changes in mean health-related quality-of-life scores and the probability of regaining baseline levels of health-related quality of life were compared between treatment groups. All statistical tests were two-sided. Urinary incontinence was more common after prostatectomy (n = 307) than after brachytherapy (n = 90) or external beam radiation therapy (n = 78) (both P < .001), whereas voiding and storage urinary symptoms were more prevalent after brachytherapy than after prostatectomy (both P < .001). Sexual dysfunction profoundly affected all three treatment groups, with a lower likelihood of regaining baseline function after prostatectomy than after external beam radiation therapy or brachytherapy (P < .001). Bowel dysfunction was more common after either form of radiation therapy than after prostatectomy. These results may guide decision making for treatment selection and clinical management of patients with health-related quality-of-life impairments after treatment for localized prostate cancer.
| CONTEXT AND CAVEATS Prior knowledge In the absence of definitive results from randomized controlled clinical trials, treatment of localized prostate cancer is often selected by use of therapeutic side effects. Study design Questionnaire-based study of health-related quality-of-life outcomes for patients 48 months after treatment for localized prostate cancer that included prostatectomy, brachytherapy, or external beam radiation therapy. Questionnaires were completed before treatment and at 11 different times during the 48 months after treatment. Contribution Urinary incontinence was more common after prostatectomy. Voiding and storage urinary symptoms were more common after brachytherapy. Sexual dysfunction profoundly affected all three treatment groups, with the lowest likelihood of regaining baseline function after prostatectomy. Bowel dysfunction was more common after either form of radiation therapy. Implications Results from this study provide information that can be used to select the best treatments for individual patients with prostate cancer. Limitations Patients may have undergone treatments that were discordant with preexisting conditions (eg, subjects treated with radiation therapy had worse bowel function scores at baseline, which grew worse with treatment). Subjects whose cancer recurred were not analyzed separately, which might have biased the results toward poorer outcomes. From the Editors
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Manuscript received November 19, 2008; revised March 18, 2009; accepted April 6, 2009.
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J Natl Cancer Inst 2009 101: 835.
J Natl Cancer Inst 2009 101: 835.
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