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Quality of Life After Treatment for Prostate Cancer: No Difference Between Surgery and Radiotherapy?

University of Wuerzburg Wuerzburg, Germany

To the Editor: We read with great interest the recent article by Penson et al,¹ reporting on general health-related quality of life (HRQOL) outcomes in a cohort of 2,306 assessable patients, diagnosed in 1994 and 1995, 2 years after treatment with either radical prostatectomy (RP), radiotherapy (RT), hormone ablation, or watchful waiting. The main results were that no significant differences between the various treatment modalities were detected, and that impaired urinary and sexual function and the resulting bother were associated with significantly reduced scores in the majority of general HRQOL domains assessed. Such studies comparing quality of life between different modalities of prostate cancer treatment are of great importance, given that the rates of tumor control appear to be remarkably similar between different treatment approaches, as supported by a recent interspecialty comparison of data from leading centers.² Penson et al¹ confirm prospectively previous findings that the profile of organ toxicity is treatment-specific and that this toxicity has an impact on general HRQOL domains.^3,4

Despite repeatedly stating that there are no significant differences in general HRQOL between treatment groups, the article by Penson et al¹ does not convince us that HRQOL was equal after surgery and RT. It appears striking that although they give scores for each HRQOL domain by subgroup (good v poor urinary function, etc), the authors do not present such raw data for the different treatment groups, but rather show only global means for the overall cohort. Also, the different grouping of patients at baseline (eg, "any urinary leak" v "total cohort") and at 2 years ("frequent leakage/no control" v "occasional leakage/total control") prevents the reader from estimating the true impact of each treatment on organ function. Despite this limitation, the effect of RP on urinary function ("any leak" at baseline, 12%; "frequent leakage/no control" at 2 years, 21.5%) compares unfavorably to that of RT ("any leak" at baseline, 25%; "frequent leakage/no control" at 2 years, 3.3%). This observation in conjunction with the impact of urinary function on HRQOL in the overall cohort would make us suspect that there should be at least a trend toward better HRQOL after RT than after RP. Considering the large size of the cohort, it would be of great interest to present the HRQOL data for each treatment modality in order to avoid any bias in data interpretation. Any conclusion from possible HRQOL differences between treatment approaches for current clinical practice will have to be drawn with care, as advances in both surgical and radiotherapeutic techniques since the mid-1990s have been shown to decrease organ toxicity and improve quality of life.^5,6

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The authors indicated no potential conflicts of interest.

REFERENCES

1. Penson DF, Feng Z, Kuniyuki A, et al: General quality of life 2 years following treatment for prostate cancer: What influences outcome? Results from the Prostate Cancer Outcomes Study. J Clin Oncol 21:1147–1154, 2003[Abstract/Free Full Text]

2. Vicini AF, Martinez A, Hanks G, et al: An interinstitutional and interspecialty comparison of treatment outcome data for patients with prostate carcinoma based on predefined prognostic categories. Cancer 95:2126–2135, 2002[Medline]

3. Wei JT, Dunn RL, Sandler HM, et al: Comprehensive comparison of health-related quality of life after contemporary therapies for localized prostate cancer. J Clin Oncol 20:557–566, 2002[Abstract/Free Full Text]

4. Vordermark D, Schwab M, Flentje M, et al: Chronic fatigue after radiotherapy for carcinoma of the prostate: correlation with anorectal and genitourinary function. Radiother Oncol 62:293–297, 2002[Medline]

5. Gralnek D, Wessells H, Cui H, et al: Differences in sexual function and quality of life after nerve sparing and nonnerve sparing radical retropubic prostatectomy. J Urol 163:1166–1169, 2000[CrossRef][Medline]

6. Dearnaly DP, Khoo VS, Norman AR, et al: Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomized trial. Lancet 353:267–272, 1999[CrossRef][Medline]

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• In Reply:
  David F. Penson and Janet L. Stanford
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This Article 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 Google Scholar Google Scholar Articles by Vordermark, D. Articles by Koelbl, O. Search for Related Content PubMed PubMed Citation Articles by Vordermark, D. Articles by Koelbl, O. Related Articles Related Article Social Bookmarking                            What's this?