Long-term Health-related Quality of Life After Primary Treatment for Localized Prostate Cancer: Results from the CaPSURE Registry

Abstract

a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Outcome measurements and statistical analysis: The Medical Outcomes Studies 36-item Short Form and the University of California, Los Angeles, Prostate Cancer Index characterized physical function, mental health, and sexual, urinary, and bowel function and bother. Repeated measures mixed-model analysis assessed change in HRQOL by treatment over time, and logistic regression was used to measure the likelihood of a clinically significant decline in HRQOL. Results and limitations: Among 3294 men, 1139 (34%) underwent nerve-sparing radical prostatectomy (NSRP), 860 (26%) underwent non-NSRP, 684 (21%) underwent brachytherapy, 386 (12%) underwent external beam radiotherapy, 161 (5%) underwent primary androgen deprivation therapy, and 64 (2%) pursued watchful waiting/active surveillance. Median follow-up was 74 mo (interquartile range: 50-102). Most treatments resulted in early declines in HRQOL, with some recovery over the next 1-2 yr and a plateau in scores thereafter. Surgery had the largest impact on sexual function and bother and on urinary function, radiation had the strongest effect on bowel function, and androgen deprivation therapy had the strongest effect on physical function. The main limitation was attrition among the cohort. Conclusions: Although most men experience initial declines in HRQOL in the first 2 yr after treatment, there is little change from 3 to 10 yr and most differences between treatments attenuated over time. Patient summary: Various treatments for prostate cancer result in a distinct constellation of adverse effects on health-related quality of life, which may have a long-term impact. These findings are helpful regarding shared decision making over choice of primary treatment. Article info

Prostate Cancer Registries: Current Status and Future Directions

“…Data on health-related quality of life after treatment can also be analyzed. Sexual dysfunction and urinary incontinence and/or irritative symptoms are common long-term sequelae after PCa treatment [35,95]. Since the incidence of erectile dysfunction and urinary incontinence may vary substantially according to definition, the use of patient-reported outcomes and validated questionnaires is preferred [96][97][98][99][100].…”

“…Long-term oncologic outcomes for combined ADT in stage IV PCa [32] Prospective patient registries CaPSURE: UCSF Cancer of the Prostate Strategic Urologic Research Endeavor Development and validation of the CAPRA score to predict pathologic and biochemical outcomes after RP [129] Time trends and variation in primary treatment of PCa in the USA [130] Long-term health-related quality-of-life outcomes after PCa treatment [95] Comparative effectiveness of RP, radiotherapy, and ADT in patients with clinically localized PCa [89] Impact of ADT on physical, mental, and emotional wellbeing in PCa patients [131] Association between race and the likelihood of upgrading, upstaging, and positive surgical margins at RP [132] Cost burden of PCa according to treatment type [106] MUSIC: Michigan Urological Survey Improvement Collaborative…”

The Risks and Benefits of Current Treatment Options for Prostate Cancer and Future Possibilities in Advanced Imaging and Targeted Therapy: A Review

“…Multiple studies, including data from the U.S. CaPSURE registry, have shown that radical prostatectomy patients are more likely to suffer from urinary incontinence than radiotherapy patients and are also more likely to have higher rates of impotency, although both groups report high erectile dysfunction rates (62-94%) [31][32][33][34]. Complications related to bowel function affect individuals treated by both radical prostatectomy and radiotherapy, but radiotherapy patients have been indicated to experience more significant declines [32][33][34].…”

“…However, multiple studies have revealed that while no significant difference in overall health-related quality of life exists between prostate cancer patients who have undergone radical prostatectomy and age-adjusted controls, the sexual, bowel, and urinary functions of radical prostatectomy patients have declined more substantially than that of controls [36][37][38][39]. Multi-model treatment and particularly the use of androgen deprivation therapy have been associated with the highest risk of adverse effects and the greatest impairment to physical function [34,39,40].…”

The New US Preventive Services Task Force “C” Draft Recommendation for Prostate Cancer Screening

“…Their choice of cohorts to include, moreover, was far from inclusive and overemphasized outdated studies, thus leading to overestimation of the harms. The inadequacy of the literature review on this question is evident, for example, in the selection of references for the PCOS and CaPSURE cohorts which were over a decade out of date relative to more recent papers [19,20]. Cohorts such as PROST-QA [21] were excluded entirely, as were large meta-analyses [22][23][24][25] and other data sources.…”