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Long-Term Outcomes Among Localized Prostate Cancer Survivors: Health-Related Quality-of-Life Changes After Radical Prostatectomy, External Radiation, and Brachytherapy

From the Michigan Urology Center and Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, MI; and Division of Urology, Beth Israel-Deaconess Medical Center, Harvard Medical School, Boston, MA

Address reprint requests to John T. Wei, MD, MS, Department of Urology, Taubman Health Care Center, University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0330; e-mail: jtwei{at}umich.edu

PURPOSE: We sought to elucidate long-term changes in health-related quality-of-life (HRQOL) outcomes by prospectively re-evaluating a well-characterized cohort of prostate cancer (PC) survivors 4 to 8 years after primary treatment.

PATIENTS AND METHODS: Patients who had been evaluated previously at a median of 2.6 years after radical prostatectomy (RP), external radiation (three-dimensional conformal radiation therapy [3-D CRT]), or brachytherapy (BT) were recontacted at a median of 6.2 years after treatment. The clinical relevance of long-term HRQOL impairment among survivors was established by comparison with controls of similar age. Factors associated with HRQOL changes during this interval were evaluated.

RESULTS: Of the 964 eligible men, 709 (73.5%) completed measurable questionnaires. In four domains (urinary irritative-obstructive, urinary incontinence, bowel, and sexual), significant HRQOL differences were detected for at least one of the therapy groups, compared with controls (all P < .05). During the 4-year interval, significant improvement was observed for the urinary irritative-obstructive (P < .0001) and bowel (P < .0001) domains among BT patients, whereas urinary incontinence HRQOL worsened for both the BT (P = .0017) and 3-D CRT (P = .0008) treatment groups. Overall sexual HRQOL deteriorated for the 3-D CRT cohort (P = .0017), as well as for controls (P = .0136). Among RP patients, significant HRQOL changes were not observed.

CONCLUSION: During a 4-year interval from earlier to longer-term phases of PC treatment survivorship, sexual, urinary, and bowel dysfunction remain significant concerns among early-stage PC treatment survivors, compared with control men. Although postprostatectomy HRQOL remains relatively stable during this interval, disease-specific HRQOL continues to evolve among men treated with BT and 3-D CRT.

Supported by National Institutes of Health (NIH) 1-T-32 DKO7782 (D.C.M.), NIH RO1 CA95662-01 (M.G.S.), and NIH 1P50CA69568 (J.E.M., J.T.W.).

Presented in part at the American Urological Association Annual Meeting, San Francisco, CA, May 8-13, 2004.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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