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Journal of Clinical Oncology, Vol 23, No 12 (April 20), 2005: pp. 2772-2780 © 2005 American Society of Clinical Oncology. DOI: 10.1200/JCO.2005.07.116 Long-Term Outcomes Among Localized Prostate Cancer Survivors: Health-Related Quality-of-Life Changes After Radical Prostatectomy, External Radiation, and BrachytherapyFrom 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.
Currently, the most common therapeutic options for localized prostate cancer are radical prostatectomy (RP), external radiation (three-dimensional conformal radiation therapy [3-D CRT]), and interstitial brachytherapy (BT). Each of these interventions has undergone significant refinement in the last 10 years and can independently achieve higher than 95% cancer-specific survival at 5 years after primary treatment.1-6 This setting has fueled an increased emphasis on the importance of health-related quality-of-life (HRQOL) outcomes. To date, studies of prostate cancer HRQOL have focused on two distinct but complementary priorities: defining the prevalence and severity of adverse urinary, sexual, and bowel HRQOL effects during the early survivorship period (1 to 4 years) after prostate cancer treatment; and establishing patient-reported data, rather than physician-reported data, as the standard methodology for characterizing the HRQOL effects of prostate cancer and its treatment.7-17 Despite this work, there remains a paucity of data that examine patient-reported HRQOL changes and outcomes during the later survivorship phase (4 to 8 years) after RP, 3-D CRT, and BT.18 Furthermore, existing population-based prostate cancer outcome studies are limited in their ability to evaluate these concerns because they do not include sufficient numbers of patients treated with either BT or 3-D CRT.14,19-21 In our efforts to better understand the HRQOL effects of prostate cancer therapy, we previously used the validated, patient-administered Expanded Prostate Cancer Index Composite (EPIC) questionnaire to assess HRQOL outcomes among a cohort of men at a median of 2.6 years after their treatment with BT, 3-D CRT, or RP, and compared HRQOL status among these prostate cancer survivors to age-matched control men.12,22,23 We now prospectively revisit this cohort 4 years later, at a time when the participating prostate cancer survivors are a median of 6.2 years after primary treatment, to characterize and compare long-term, patient-reported HRQOL changes and outcomes during a later phase of prostate cancer treatment survivorship.
A total of 1,014 men, including 902 patients treated with RP, 3-D CRT, or BT as primary therapy for localized prostate cancer (during the 4-year period from June 1, 1995, to May 31, 1999), and 112 prostate cancer–and prostate surgery–free controls participated in our prior cross-sectional survey.12 The details of control group recruitment have been described previously and the control sample was frequency matched to the treatment group by decade of age.12 Inclusion criteria for the follow-up assessment described herein include patient participation in the prior 1999 cross-sectional evaluation and survival at a sufficient state of health for the patient to be able to provide informed consent for participation for the current study. Forty-four men had died in the interval since our first assessment and, therefore, were excluded from this analysis. Also excluded were six participants from the first study who had requested not to be contacted for additional participation in a similar survey. On the basis of these criteria, 964 patients were eligible for the current study (665 patients treated with RP, 147 patients treated with 3-D CRT, 84 patients treated with BT, and 112 controls).
Study Measures
Study Procedures
Statistical Analyses Long-term HRQOL domain scores were then compared between each of the three treatment groups and controls using analysis of covariance (ANCOVA) models, adjusted for age. For comparisons between therapy groups and controls, the Bonferroni multiple comparison adjustment was used to preserve the overall significance level. Next, data from the current assessment were combined with those from our earlier cross-sectional study to calculate therapy-specific changes in each of the HRQOL domains. ANCOVA models were created to determine treatment effect on the change in HRQOL scores between short-term (1999) and long-term (2003) assessments. To adjust for differences between the therapy groups and controls, age was included as a covariate in these models. Separate posthoc tests were then performed to determine whether the age-adjusted change in HRQOL score for each treatment group and controls was significantly different from zero. To identify factors independently associated with long-term HRQOL changes, multivariate ANCOVA models were again constructed (for each treatment group, but not controls) with changes in HRQOL domain scores as the dependent variable and treatment group (RP, BT, 3-D CRT), age (years), length of follow-up (months), baseline PSA (nanograms per milliliter), Gleason sum (< 7, 7, > 7), and clinical T stage (T1, T2, T3) as independent covariates. Given the absence of cancer-specific data, control men were not included in this analytic step. A backward model building procedure was used to select the most parsimonious model, with separate model building procedures performed for changes in each of the two general (SF-12 MCS and PCS) and five cancer-specific (urinary irritative, urinary incontinence, sexual, bowel, and hormonal) HRQOL domains. The 5% significance level was used in all tests and comparisons, and all statistical analyses were performed using SAS software (SAS Institute, Cary, NC).
Of the 964 eligible men, 709 (overall response rate, 73.5%) consented to participate and completed measurable questionnaires. Baseline demographic and cancer-specific variables for current study participants are summarized in Table 1.
In the current study, age-adjusted, general (SF-12 PCS and MCS), and disease-specific (EPIC) HRQOL scores were determined for each treatment cohort and for controls; higher values for both the SF-12 and EPIC domains represent more favorable HRQOL outcomes. To ascertain the clinical relevance of observed HRQOL states associated with prostate cancer treatment survivorship beyond 4 years after primary treatment, we compared HRQOL scores for each therapy group with those of control men (Table 2). Consistent with our findings from the early survivorship period, RP was associated with worse sexual HRQOL (P < .0001) and urinary incontinence (P = .0002) relative to controls.12 Sexual and bowel HRQOL were significantly poorer among 3-D CRT patients relative to controls (P < .0001). BT patients reported significantly lower HRQOL compared with controls in four of the five EPIC domains (urinary irritative-obstructive, urinary incontinence, bowel, and sexual; all P < .01; Table 2). In contrast, measures of general HRQOL (SF-12 PCS and MCS) remained similar for each treatment group and controls (all P > .20 for comparisons between treatment groups and controls).
We then evaluated changes in general and disease-specific HRQOL that occurred between our initial (2.6-year median follow-up for all patients) and current (6.2-year median follow-up for all patients) assessments. No significant changes in SF-12 measures were observed for any treatment group (data not shown) or controls. Age-adjusted changes in prostate cancer-specific HRQOL domains are compared for each treatment group and controls in Figure 1. As patients transition from early to later stages of survivorship, significant improvement was observed for the urinary irritative-obstructive domain among BT patients (P < .0001), whereas urinary incontinence HRQOL worsened among both BT (P = .0017) and 3-D CRT patients (P = .0008). Bowel HROQL also improved among BT patients (P < .0001). Overall sexual HRQOL deteriorated for the 3-D CRT cohort (P = .0017) and controls (P = .0136). Among RP patients, urinary, bowel, and sexual HRQOL were similar at long-term (median, 6.2 years) and earlier (median, 2.6 years) follow-up. To characterize the evolving symptoms that underscore these long-term HRQOL changes, Table 3 lists the responses, between the initial and current assessments, to all EPIC-26 items dichotomized according to clinically relevant strata in the response options. In general, impairment related to urinary and bowel function changed in accordance with overall HRQOL. Consistent with their global HRQOL outcomes, BT patients reported less bother over time for both the urinary (16% v 23% with moderate to severe problems related to urinary function) and bowel (10% v 17% with moderate to severe problems related to overall bowel habits) domains (Table 3). Eleven percent of the 3-D CRT cohort reported currently having moderate to severe problems with urinary function versus only 8% at the time of our initial assessment. Overall levels of sexual impairment decreased for all three treatment cohorts during this same time interval (Table 3). After adjustment for age, length of follow-up, and baseline prostate cancer severity (baseline PSA, Gleason sum, T stage), type of therapy was independently associated with long-term changes in the urinary irritative (P < .0001), urinary incontinence (P = .0016), bowel (P < .0001), and sexual (P = .0033) HRQOL domains. Age was independently associated with long-term changes in urinary incontinence (P < .0001) and hormonal HRQOL (P = .0069), whereas length of follow-up was associated with changes in sexual HRQOL (P < .0001).
With continued follow-up of a well-characterized cohort, we observed that general HRQOL remains largely favorable up to 8 years after treatment with RP, 3-D CRT, or BT. Consistent with prior short-term assessments, general HRQOL, as measured by the SF-12 PCS and MCS, does not differ based on therapy choice and is similar among prostate cancer patients and controls.19,25 However, relative to control patients, longer follow-up confirms that sexual, urinary, and bowel dysfunction remain more prevalent and bothersome among men treated for localized prostate cancer. Notably, we found that disease-specific HRQOL continues to evolve among men treated with BT and 3-D CRT, whereas postprostatectomy HRQOL remains relatively stable during extended follow-up. On the basis of our current findings, improvements in urinary control that have previously been observed in the first 2 years of post-RP recovery appear not to extend substantially thereafter.21,26-29 However, during this later phase of post-treatment survivorship (beyond 2 years after treatment), urinary incontinence appears to manifest as a progressive concern among men treated with BT and/or 3-D CRT. Indeed, we observed that BT and 3-D CRT patients alike endured a significant decline in urinary incontinence HRQOL during the 4-year interval between our initial and current assessments. The clinical correlates of this global decline in urinary incontinence HRQOL include an increase in the proportion of patients (both BT and 3-D CRT) with frequent and problematic urinary dribbling, as well as an increase in pad requirements for the radiation cohorts. Previously, the potential for worsening urinary incontinence after external radiation has not been well characterized among long-term survivors (eg, > 4 years after primary intervention). In contrast to our findings, Fransson and Widmark30 noted no significant change in either urinary incontinence or overall urinary function between 4 and 8 years of follow-up after conventional external-beam radiotherapy. These disparate findings should prompt future studies that specifically evaluate this concern during the late phases of prostate cancer survivorship after 3-D CRT. For men treated with BT, long-term problems with postimplant urinary control have been described in a separate series that specifically characterized patient-reported HRQOL among 72 men at a median follow-up of 5 years after seed implantation as monotherapy.31 Using liberal definitions of urinary incontinence, Talcott et al31 observed that 40% of BT patients reported some degree of urinary leakage within the last week. However, application of this definition of incontinence to our sample would actually designate a significant number of control men as incontinent, despite the absence of concurrent problems (eg, bother) related to such occasional weekly episodes of urinary dribbling. As a result, the clinical relevance of defining incontinence on the basis of this liberal threshold may be questioned. Unlike Talcott et al, Merrick et al32 reported no differences in long-term (median follow-up, 64 months) urinary control, based on EPIC incontinence domain summary scores, when BT survivors were compared with a group of newly diagnosed (but untreated) prostate cancer patients. Ultimately, reconciliation of these disparate outcomes will require multi-institutional, prospective studies of post-BT urinary HRQOL that not only measure baseline urinary control, but also consider the potential impact of various technical factors, including treatment planning and urethral dosimetry.32 In contrast to urinary incontinence, the greatest improvement in HRQOL, during the interval between our initial and current assessments, was in the urinary irritative domain among BT patients. This recovery in global urinary irritative QOL among BT survivors is explained by consistent improvement in multiple urinary symptoms including pain/burning on urination, urinary frequency, and hematuria. Although unlikely, one potential explanation for this finding is a regression to the mean phenomenon whereby the unfavorable urinary irritative outcomes for BT patients in the first wave of this study render future assessments more likely to observe improvement in this domain for the BT cohort. Despite this concern, our findings are nonetheless consistent with several prospective patient series that describe a high prevalence of new-onset or progressive urinary irritative and/or obstructive symptomatology after brachytherapy; however, these studies also suggest that improvement in this domain may be anticipated within 1 to 2 years from the time of implantation.33-36 Our results both confirm and extend this prior work by demonstrating that significant and bothersome increases in urinary irritative and obstructive symptomatology may be primarily limited to the first 2 years after brachytherapy. With time, these post-BT urinary irritative and obstructive concerns diminish and, in fact, may continue to improve for up to 8 years after treatment. This study also furthers our appreciation of the evolving rectal manifestations of treatment for localized prostate cancer. Existing research has consistently demonstrated that bowel dysfunction, including diarrhea, painful bowel movements, and rectal bleeding, is significantly more prevalent after radiation therapy (BT or 3-D CRT) versus radical prostatectomy.14,26,29 Although the individual symptoms may vary, it has been shown that lower GI concerns continue to evolve and/or progress within the first 2 years after 3-D CRT and BT.12,14,26,37 Our data show that, although problems with bowel urgency, frequency, fecal control, hematochezia, and rectal pain persist among a subset of BT patients 4 to 8 years after treatment, such rectal morbidity was less problematic than in the first 2 years of follow-up. Notably, because bowel and rectal symptoms among BT patients were worse than those in 3-D CRT patients during the early survivorship phase,12 the interval improvement among BT survivors led to a convergence in overall bowel HRQOL for these two groups in the later phase of survivorship. This study also provides novel insight regarding long-term sexual outcomes among localized prostate cancer treatment survivors. In the 4 years since our last assessment, a significant change in sexual HRQOL was observed for only one therapy group, with 3-D CRT patients reporting a decline in function for this domain. It is important to note that the change in sexual HRQOL among men treated with external radiation was mirrored by our control sample, suggesting a possible effect of aging rather than an evolving radiation insult. However, our findings are consistent with a recent report from the Prostate Cancer Outcomes Study that demonstrated large declines in sexual function, between 2 and 5 years after treatment, among men treated with conventional external-beam radiotherapy.38 The absence of detected change in sexual HRQOL for the RP and BT cohorts also merits additional comment. One potential explanation for the observed stabilization of sexual HRQOL among RP and BT survivors is the possibility, as reported by others, of a greater prevalence of therapy for sexual dysfunction after these treatments.39 In our cohort, 38% of RP patients, 17% of 3-D CRT patients, and 19% of BT patients were current users of medications or devices to aid erectile function; details regarding past and current specific medication usage, and how that related to sexual HRQOL among these participants are described in a separate article.40 Possible differences in baseline sexual function that were not measured for this study sample may also influence the long-term outcomes reported herein. An additional consideration is that a more substantial early decline in sexual function may render RP and BT patients less susceptible to additional long-term decrements in sexual HRQOL. Finally, the sexual HRQOL score evaluated herein includes a composite of function and bother items, and it is possible that these domains may continue to evolve in opposing manners, thereby masking actual changes in sexual function and bother (for example, the effects of worsening sexual function on the sexual summary score may be offset by concurrent reductions in patient bother due to ongoing adaptation to this change in health status). Notably, our observation that disease-specific HRQOL remains generally stable between 2 and 6 years of follow-up after radical prostatectomy may have important implications for future clinical research. One possible inference from this finding is that men with favorable HRQOL in the first 2 years after radical prostatectomy will maintain such favorable outcomes for up to 8 years; conversely, men with unfavorable HRQOL at 2 years post-RP are likely to experience persistently adverse outcomes during this same interval. In this context, our findings may provide novel justification for additional studies that further explore the underpinnings of the relationship between surgical volume and postprostatectomy outcomes, particularly given the preliminary conclusions that higher surgical volume is associated with less morbidity and, presumably, superior short-term HRQOL.41,42 Our results also highlight the pressing need for more precise characterization of HRQOL outcomes and changes among long-term treatment survivors in a prospective, multicenter study. Such prospective data are essential to help newly diagnosed patients make decisions now about various treatment options that will undoubtedly affect their future health status, and we have embarked on such a study: the Prostate Cancer Outcomes and Satisfaction With Treatment Quality Assessment (PROST-QA) Consortium, sponsored by the National Cancer Institute (R01 CA95662-01). While awaiting results of this and other prospective, multicenter studies (which will not be completed for several years), the characterization of long-term prostate cancer HRQOL outcome evolution in single-center studies such as reported herein serves as a guide for clinicians and patients (in the early phase of survivorship) alike regarding HRQOL change or stability that is anticipated during follow-up from earlier to later stages of survivorship. There are several limitations to this study. First, data regarding pretreatment HRQOL were not available for this study sample. As a result, we were unable to control for unmeasured differences in baseline function between treatment groups, and this precludes direct comparison of final HRQOL status between treatment groups. Nevertheless, our findings provide a basis for patients who have selected a specific treatment to anticipate long-term HRQOL changes that may be observed, in particular, from an average of 2.6 to 6.2 years after treatment. Second, although our comparative analyses were controlled for potential confounding variables including age and cancer severity, selection bias and nonresponse bias may influence the HRQOL outcomes reported herein. In particular, age and HRQOL differences between respondents and nonrespondents in the RP cohort raise a concern that the results for our surgical sample may be more favorable than would be observed among all men treated with radical prostatectomy. Moreover, our inability to distinguish between current and former use of androgen deprivation therapy precluded adjustment for the (adverse) effect of hormone ablation on long-term sexual HRQOL. Finally, our report reflects the outcomes experienced by patients at a single, high-volume referral center with pre-established expertise in each treatment modality. Hence, the possibility that regional variation or variance in practitioner expertise may affect these outcomes cannot be evaluated in this cohort. Nonetheless, our data provide important estimates of long-term HRQOL changes in the context of patient self-selection, which reflects the current clinical reality of therapy for localized prostate cancer. In summary, our findings demonstrate evolving and potentially unexpected changes in long-term, patient-reported HRQOL as prostate cancer patients proceed from earlier to later phases of survivorship after RP, 3-D CRT, or BT. Four to 8 years after primary therapy, we observed improvements in urinary irritation and bowel symptoms among BT patients, and worsening urinary incontinence in BT as well as external radiation survivors. In contrast, HRQOL remained relatively stable in the interval from early to longer-term follow-up after RP. These observations highlight the need for corroborative multicenter, prospective studies that continue to evaluate changes in HRQOL outcomes during the later survivorship phases (> 5 years) after treatment for localized prostate cancer. Until such studies mature in coming years, the observed HRQOL changes described herein may help both clinicians and patients set realistic expectations regarding long-term HRQOL outcomes more than 4 years after primary treatment of early-stage prostate cancer.
The authors indicated no potential conflicts of interest.
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.
1. Catalona WJ, Bigg SW: Nerve-sparing radical prostatectomy: Evaluation of results after 250 patients. J Urol 143:538-543, 1990[Medline] 2. Blasko JC, Mate T, Sylvester JE, et al: Brachytherapy for carcinoma of the prostate: Techniques, patient selection, and clinical outcomes. Semin Radiat Oncol 12:81-94, 2002 3. Blasko JC, Wallner K, Grimm PD, et al: Prostate specific antigen based disease control following ultrasound guided 125iodine implantation for stage T1/T2 prostatic carcinoma. J Urol 154:1096-1099, 1995[CrossRef][Medline] 4. Blasko JC, Ragde H, Luse RW, et al: Should brachytherapy be considered a therapeutic option in localized prostate cancer? Urol Clin North Am 23:633-650, 1996[CrossRef][Medline]
5. Gerber GS, Thisted RA, Scardino PT, et al: Results of radical prostatectomy in men with clinically localized prostate cancer. JAMA 276:615-619, 1996
6. Pound CR, Partin AW, Eisenberger MA, et al: Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281:1591-1597, 1999
7. Litwin MS, McGuigan KA: Accuracy of recall in health-related quality-of-life assessment among men treated for prostate cancer. J Clin Oncol 17:2882-2888, 1999 8. Litwin MS, Lubeck DP, Henning JM, et al: Differences in urologist and patient assessments of health related quality of life in men with prostate cancer: Results of the CaPSURE database. J Urol 159:1988-1992, 1998[CrossRef][Medline] 9. Litwin MS: Examining health-related quality of life in men treated for prostate cancer. World J Urol 17:205-210, 1999[CrossRef][Medline]
10. Litwin MS, Hays RD, Fink A, et al: Quality-of-life outcomes in men treated for localized prostate cancer. JAMA 273:129-135, 1995 11. Litwin MS, Hays RD, Fink A, et al: The UCLA Prostate Cancer Index: Development, reliability, and validity of a health-related quality of life measure. Med Care 36:1002-1012, 1998[CrossRef][Medline]
12. 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 13. Schapira MM, Lawrence WF, Katz DA, et al: Effect of treatment on quality of life among men with clinically localized prostate cancer. Med Care 39:243-253, 2001[CrossRef][Medline]
14. Potosky AL, Legler J, Albertsen PC, et al: Health outcomes after prostatectomy or radiotherapy for prostate cancer: Results from the Prostate Cancer Outcomes Study. J Natl Cancer Inst 92:1582-1592, 2000
15. Talcott JA, Rieker P, Propert KJ, et al: Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy. J Natl Cancer Inst 89:1117-1123, 1997
16. Talcott JA, Rieker P, Clark JA, et al: Patient-reported symptoms after primary therapy for early prostate cancer: Results of a prospective cohort study. J Clin Oncol 16:275-283, 1998
17. Madalinska JB, Essink-Bot ML, de Koning HJ, et al: Health-related quality-of-life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer. J Clin Oncol 19:1619-1628, 2001 18. Penson DF, Litwin MS, Aaronson NK: Health related quality of life in men with prostate cancer. J Urol 169:1653-1661, 2003[CrossRef][Medline]
19. Penson DF, Feng Z, Kuniyuki A, et al: General quality of life 2 years following treatment for prostate cancer: What influences outcomes? Results from the prostate cancer outcomes study. J Clin Oncol 21:1147-1154, 2003
20. Potosky AL, Harlan LC, Stanford JL, et al: Prostate cancer practice patterns and quality of life: The Prostate Cancer Outcomes Study. J Natl Cancer Inst 91:1719-1724, 1999
21. Stanford JL, Feng Z, Hamilton AS, et al: Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: The Prostate Cancer Outcomes Study. JAMA 283:354-360, 2000 22. Wei JT, Dunn RL, Litwin MS, et al: Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology 56:899-905, 2000[CrossRef][Medline] 23. Hollenbeck BK, Dunn RL, Wei JT, et al: Neoadjuvant hormonal therapy and older age are associated with adverse sexual health-related quality-of-life outcome after prostate brachytherapy. Urology 59:480-484, 2002[CrossRef][Medline] 24. Ware J Jr, Kosinski M, Keller SD: A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med Care 34:220-233, 1996[CrossRef][Medline] 25. Downs TM, Sadetsky N, Pasta DJ, et al: Health related quality of life patterns in patients treated with interstitial prostate brachytherapy for localized prostate cancer: Data from CaPSURE. J Urol 170:1822-1827, 2003[CrossRef][Medline]
26. Talcott JA, Manola J, Clark JA, et al: Time course and predictors of symptoms after primary prostate cancer therapy. J Clin Oncol 21:3979-3986, 2003 27. Litwin MS, Melmed GY, Nakazon T: Life after radical prostatectomy: A longitudinal study. J Urol 166:587-592, 2001[CrossRef][Medline] 28. Penson DF, Litwin MS: Quality of life after treatment for prostate cancer. Curr Urol Rep 4:185-195, 2003[Medline] 29. Litwin MS, Pasta DJ, Yu J, et al: Urinary function and bother after radical prostatectomy or radiation for prostate cancer: A longitudinal, multivariate quality of life analysis from the Cancer of the Prostate Strategic Urologic Research Endeavor. J Urol 164:1973-1977, 2000[CrossRef][Medline] 30. Fransson P, Widmark A: Late side effects unchanged 4-8 years after radiotherapy for prostate carcinoma: A comparison with age-matched controls. Cancer 85:678-688, 1999[CrossRef][Medline] 31. Talcott JA, Clark JA, Stark PC, et al: Long-term treatment related complications of brachytherapy for early prostate cancer: A survey of patients previously treated. J Urol 166:494-499, 2001[CrossRef][Medline] 32. Merrick GS, Wallner KE, Butler WM: Minimizing prostate brachytherapy-related morbidity. Urology 62:786-792, 2003[CrossRef][Medline] 33. Stone NN, Stock RG: Complications following permanent prostate brachytherapy. Eur Urol 41:427-433, 2002[CrossRef][Medline] 34. Lee WR, McQuellon RP, Harris-Henderson K, et al: A preliminary analysis of health-related quality of life in the first year after permanent source interstitial brachytherapy (PIB) for clinically localized prostate cancer. Int J Radiat Oncol 46:77-81, 2000[CrossRef][Medline] 35. Al Booz H, Ash D, Bottomley DM, et al: Short-term morbidity and acceptability of 125iodine implantation for localized carcinoma of the prostate. BJU Int 83:53-56, 1999[CrossRef][Medline] 36. Henderson A, Cahill D, Laing RW, et al: (125)Iodine prostate brachytherapy: Outcome from the first 100 consecutive patients and selection strategies incorporating urodynamics. BJU Int 90:567-572, 2002[CrossRef][Medline]
37. Beard CJ, Propert KJ, Rieker PP, et al: Complications after treatment with external-beam irradiation in early-stage prostate cancer patients: A prospective multiinstitutional outcomes study. J Clin Oncol 15:223-229, 1997
38. Potosky AL, Davis WW, Hoffman RM, et al: Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: The Prostate Cancer Outcomes Study. J Natl Cancer Inst 96:1358-1367, 2004 39. Schover LR, Fouladi RT, Warneke CL, et al: The use of treatments for erectile dysfunction among survivors of prostate carcinoma. Cancer 95:2397-2407, 2002[CrossRef][Medline] 40. Miller DC, Wei JT, Dunn RL, et al: The prevalence and outcome of therapy for erectile dysfunction 4 to 8 years following brachytherapy, external radiation and radical prostatectomy for localized prostate cancer. J Urol 171:239-240, 2004 (suppl)
41. Begg CB, Riedel ER, Bach PB, et al: Variations in morbidity after radical prostatectomy. N Engl J Med 346:1138-1144, 2002
42. Hu JC, Gold KF, Pashos CL, et al: Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol 21:401-405, 2003 Submitted July 15, 2004; accepted January 19, 2005.
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Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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ABSTRACT
INTRODUCTION
> 0.7 for each domain summary score) in item reduction analyses (conducted in the preceding validation cohort).
