Quality of Life After Definitive Treatment for Prostate Cancer. Differences Based on Treatment Modality

William Levin, MD
OncoLink Assistant Editor
Last Modified: October 25, 2000

Presenter: J. W. Davis
Affiliation: Eastern Virginia Medical School, Norfolk, VA

Background:

This is a retrospective study comparing the general health and disease-specific quality of life (HRQOL) in patients with localized prostate cancer treated with brachytherapy (PD103), external beam radiation therapy (XRT), and radical prostatectomy (RP).

Materials and Methods:

HRQOL surveys were mailed to 142 PD103, 222 XRT and 269 RP patients treated from 1995 to 1999, and returned from 120 (85%) PD103, 188 (85%) XRT, and 220 (82%) RP patients.
The survey packet included the RAND 36-item Health Survey (SF-36), UCLA prostate Cancer Index (UCLA PCI), Technology Assessment Group (TAG) Cancer Interference with Family and Life General Scales, Memorial Anxiety Scale for Prostate Cancer (MAX-PC), and AUA Symptom Index.
Aged-matched men without prostate cancer studied with the SF-36 and UCLA PCI were taken from the literature and used as controls.
Mean scores for all completed surveys in each group were recorded. Groups were then compared at 3, 6, 12, 18, 24, 36, and 48 month intervals after treatment to note trends.

Results:

Patient characteristics:
- XRT patients had significantly higher mean age (69) followed by Pd103 (67) and RP (65) (p<0.05).
- 15-18% of each group were African Americans with no significant inter-group differences.
- XRT patients had higher co-morbidity scores than RP patients.
- RP and Pd103 patients had similar Gleason scores, stage, and pre-PSA, while XRT patients were higher in all three categories.
RP and Pd103 patients had less health related limitation in physical activity and better general health than XRT or controls.
The three treatment groups were similar to each other and controls for energy/fatigue, emotional well-being, emotional effect on activity, social function, and pain assessments.
Bowel function scores were statistically the same among all treatment groups and controls.
Urinary function scores were clearly lower in the RP group, even with the improvement seen in the first 18 months after surgery, while both Pd103 and XRT patients were similar to controls.
All three treatment modalities showed diminished sexual function and related bother as compared to controls.
Sexual function was similar for the XRT and Pd103 patients, while it was worse for the RP group.
Type of surgery, ie., bilariteral nerve-sparing vs. unilateral nerve-sparing vs. non-nerve sparing, had a significant effect regarding sexual function.

Authors' Conclusions

In a retrospective, time calibrated survey of general health related and disease-specific quality of life in patients definitively treated for localized prostate cancer, significant differences based on treatment modality became evident. This information may aid patients in the decision-making process until trials measuring biochemical and overall survival endpoints are available.

Clinical/Scientific Implications:

Regarding survival, there is no definitive prospective randomized data to suggest that either RP, brachytherapy, or XRT are superior to the others for the treatment of localized prostate cancer.
Accordingly, a patient's choice of therapy should be based in-part on the expected side- effect profiles of each therapy.