This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Clark, J. A. Articles by Talcott, J. A. Search for Related Content PubMed PubMed Citation Articles by Clark, J. A. Articles by Talcott, J. A.

Patients’ Perceptions of Quality of Life After Treatment for Early Prostate Cancer

Jack A. Clark, Thomas S. Inui, Rebecca A. Silliman, Barbara G. Bokhour, Steven H. Krasnow, Richard A. Robinson, Monica Spaulding, James A. Talcott

From the Boston University School of Public Health; Boston University Medical School; Harvard Vanguard Medical Associates; Center for Outcomes Research, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital; Harvard Medical School, Boston; Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Indiana University School of Medicine; Regenstrief Institute for Health Care, Indianapolis, IN; Veterans Affairs Medical Center, Washington, DC; Veterans Affairs Western New York Health Care System; and State University of New York at Buffalo Medical School, Buffalo, NY.

Address reprint requests to Jack A. Clark, PhD, Department of Health Services, Boston University School of Public Health, 715 Albany St, T3-W, Boston, MA 02118; e-mail: jaclark{at}bu.edu.

Purpose: Treatment for early prostate cancer produces problematic physical side effects, but prior studies have found little influence on patients’ perceived health status. We examined psychosocial outcomes of treatment for early prostate cancer.

Patients and Methods: Patients with previously treated prostate cancer and a reference group of men with a normal prostate-specific antigen (PSA) level and no history of prostate cancer completed questionnaires. Innovative scales assessed behavioral consequences of urinary dysfunction, sexuality, health worry, PSA concern, perceived cancer control, treatment decision making, decision regret, and cancer-related outlook. Urinary, bowel, and sexual dysfunction were assessed with symptom indexes; health status was assessed by the Physical and Mental Summaries of the Short Form (SF-12) Health Survey.

Results: Compared with men without prostate cancer, prostate cancer patients reported greater urinary, bowel, and sexual dysfunction, but similar health status. They reported worse problems of urinary control, sexual intimacy and confidence, and masculinity, and greater PSA concern. Perceptions of cancer control and treatment decisions were positive, but varied by treatment: prostatectomy patients indicated the highest and observation patients indicated the lowest cancer control. Bowel and sexual dysfunction were associated with poorer sexual intimacy, masculinity, and perceived cancer control; masculinity and PSA concern were associated with greater confidence in treatment choice; and diminished sexual intimacy and less interest in PSA were associated with greater regret.

Conclusion: The lack of change in global measures of health status after treatment for early prostate cancer obscures important influences in men’s lives; cancer diagnosis and treatment complications may result in complex outcomes. Aggressive treatment may confer confidence in cancer control, yet be countered by diminished intimate relationships and masculinity, which accompany sexual dysfunction.

Supported by Health Services Research and Development Service Grant ECV-97081-1 from the Department of Veterans Affairs.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

This article has been cited by other articles:

				M. D. Michaelson, S. E. Cotter, P. C. Gargollo, A. L. Zietman, D. M. Dahl, and M. R. Smith Management of Complications of Prostate Cancer Treatment CA Cancer J Clin, July 1, 2008; 58(4): 196 - 213. [Abstract] [Full Text] [PDF]

				A. Katz and A. Katz The top 13: What family physicians should know about prostate cancer Can Fam Physician, February 1, 2008; 54(2): 198 - 203. [Abstract] [Full Text] [PDF]

				J. A. Talcott Prostate Cancer Quality of Life: Beyond Initial Treatment and the Patient J. Clin. Oncol., September 20, 2007; 25(27): 4155 - 4156. [Full Text] [PDF]

				J. A. Clark and J. A. Talcott Confidence and Uncertainty Long After Initial Treatment for Early Prostate Cancer: Survivors' Views of Cancer Control and the Treatment Decisions They Made J. Clin. Oncol., September 20, 2006; 24(27): 4457 - 4463. [Abstract] [Full Text] [PDF]