329: Health Related Quality of Life Outcomes Following Definitive Therapy Compared with Watchful Waiting in Localized Adenocarcinoma of the Prostate: An Analysis of the Atlanta Veterans Affairs Prostate Database

Reporter: Abigail T. Berman
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 4, 2013

Presenter: William A. Hall
Presenter’s Affiliation: Winship Cancer Institute at Emory University, Atlanta, Georgia

Prostate cancer is the most common cancer diagnosis in men. In men with prostate cancer that has not yet metastasized (spread) to other organs, surgery and radiation therapy, as well as active surveillance or watchful waiting, are effective management options. For patients to make an informed decision on how to manage their prostate cancer, they must understand the side effects related to each option.

Many studies have demonstrated that both surgery and radiation therapy are associated with urinary, sexual, and bowel symptoms, and changes in quality of life. However, some questions remain about side effects related to surgery and radiation. In particular, it is not clear how the side effects of men who undergo definitive treatment (surgery or radiation) compares with men who undergo active surveillance or watchful waiting.

Investigators from the Winship Cancer Institute at Emory University, led by Dr. William Hall, reviewed patients with prostate cancer who were managed from 1996-2004 with either definitive treatment (surgery or radiation therapy), watchful waiting or hormone therapy. Interestingly, half of the men in the study were African-American. Patients who had combination treatments were not included in the study. Urinary, bowel and sexual function data was collected from the medical charts.

The authors found that patients who received definitive treatment had worse incontinence and sexual function than patients who underwent watchful waiting or hormone therapy. Patients who received radiation therapy (external beam or brachytherapy) had worse bowel function compared to other treatments.

On closer analysis, the authors found that African-American race was a significant predictor of worse sexual function. This has been shown in previous studies, but this was a particularly meaningful finding for the authors because of the large number of African-American patients were included in the study.

For patients with prostate cancer, including African-American patients, this study highlights that surgery and radiation therapy both have risks of sexual, urinary and bowel side effects when compare to watchful waiting. This finding is important for prostate cancer patients and their doctors to consider as they discuss treatment options.