Prostate cancer active surveillance and health‐related quality of life: results of the Finnish arm of the prospective trial

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Active surveillance is a management option in patients with localized prostate cancer. One concern is the possible psychological burden and quality‐of‐life effects caused by consciousness of living with untreated cancer. Previous studies have reported controversial results about the impact of active surveillance on patient's health‐related quality of life. The data of the present study support the idea that patients with low‐risk prostate cancer manage well on active surveillance and do not develop short‐term mental or physical quality‐of‐life sequelae. OBJECTIVE To analyse longitudinal changes in general, mental and physical health‐related quality of life (HRQL) and urinary and erectile function in patients with low‐risk prostate cancer (PC) on active surveillance (AS). PATIENTS AND METHODS Patients comprised those (n= 124) enrolled in the Finnish arm of the Prostate Cancer Research International: Active Surveillance (PRIAS) study who were followed for at least 1 year (n= 80). All patients with PC received validated questionnaires at the start of surveillance and after 1 year of follow‐up. General HRQL was assessed with the RAND 36‐Item Health Survey (RAND‐36), erectile function with the International Index of Erectile Function‐5 (IIEF‐5), and urinary symptoms with the International Prostate Symptom Score (IPSS) questionnaires. Results were also compared with an age‐stratified general Finnish male population. A paired t‐test served to compare results over time and a non‐paired t‐test or a corresponding non‐parametric test, when applicable, served to compare the study group with the general population. Pearson and Spearman correlations were analysed between possible HRQL‐affecting factors (demographic and clinical data) and HRQL data, followed by linear regression analysis to further evaluate any possible associations. RESULTS Of the 124 patients, 105 (85%) returned the baseline RAND‐36 questionnaire, and 75 (94%) of the 80 patients answered both the baseline and follow‐up questionnaires; 15 patients (12%) had discontinued AS, all for protocol‐based reasons, none due to anxiety or distress. No differences existed in the HRQL main categories at the 1‐year follow‐up (mental and physical: P= 0.142 and P= 0.154, respectively). When all the eight dimensions were analysed separately, the physical role showed statistically significant improvement from a mean of 81 to a mean of 89 (P= 0.010). No clinically significant correlations appeared between HRQL and age, diagnostic prostate‐specific antigen (PSA), free PSA or PSA change during follow‐up at any of the time points; in regression analysis, HRQL was not predictable by any of the variables available at diagnosis or during follow‐up. No statistically significant changes occurred in urinary function as analysed by the IPSS (P= 0.121) or in erectile function by the IIEF‐5 questionnaire (P= 0.583). Compared with an age‐stratified Finnish general male popula...

How Does Active Surveillance for Prostate Cancer Affect Quality of Life? A Systematic Review

“…In the same study, it was highlighted that 17 AS patients with subjective perception of disease progression showed worse mental health scores than AS patients without such a perception of disease progression. In the Dutch PRIAS cohort, the baseline mental health score was associated with 9-mo follow-up scores [24] and there were no changes over 9-or 12-mo follow-up in either of the two PRIAS cohorts [24,26]. In summary, these findings do not seem to justify the concern that living with untreated cancer negatively affects the mental health of patients on AS.…”

“…No major differences were observed between the HRQoL scores of AS patients and their comparison groups [19,21,23,25,26]. There were also no major changes in HRQoL after 9 or 12 mo on AS in two PRIAS cohorts [24,26].…”

“…Four studies reported on mental health by using the SF-36 mental health index and found that patients were doing well [20,23,24,26]. Thong et al [23] found the mean mental health score of men on AS was about 80 and was similar to the mean score for a normative population, matched for age and sex, and up to 10 yr after diagnosis.…”

Quality of Life in Men Undergoing Active Surveillance for Localized Prostate Cancer

“…One-year analyses of the Finnish arm of the prospective, observational, longitudinal Prostate Cancer Research International: Active Surveillance (PRIAS) study compared general HRQOL, erectile function, urinary function, and mental health before and one year after pursuing active surveillance for low-risk prostate cancer (65). No significant changes were seen in urinary or erectile function, and neither mental nor physical HRQOL declined over time.…”

Active Surveillance for Low-Risk Prostate Cancer

“…This showed no difference in any psychological domain between the surgery and watchful waiting group, but distress was more common in the former. A recent Finnish quality of life study in 126 men on surveillance found that this approach did not provoke short-term quality-of-life disturbances, as assessed by standardized RAND-36, IIEF-5 and IPSS questionnaires [34]. None of the patients changed treatment due to anxiety.…”