Impact of Prostatectomy on Quality of Life: A Comprehensive Study on Changes in Patients With Prostate Cancer

Preface Currently, there are many wellestablished therapeutic options for early prostate cancer, and therefore, it is difficult for both urologists and patients to choose the optimal treatment. It is essential for urologists to counsel their patients according to reliable information about the advantages and disadvantages of each therapeutic option. We picked the topic for this issue, “Characteristics and management of erectile dysfunction after various treatments for prostate cancer,” because erectile dysfunction (ED) is one of the most frequent adverse events encountered in the management of prostate cancer. We invited six specialists to review each therapeutic option: radical prostatectomy, laparoscopic radical prostatectomy, robot-assisted laparoscopic radical prostatectomy, external beam radiotherapy, brachytherapy, and androgen deprivation therapy (ADT). Among these modalities, surgical interventions tend to induce a quick drop in erectile function with slow postoperative recovery. Early postoperative rehabilitation has been introduced, aiming at the early recovery of ED. On the contrary, radiation therapy tends to maintain the patient’s erectile function for a while after treatment but it gradually decreases. ADT may compromise not only the erectile function but also the libido level, and may result in significant deterioration of the patient’s quality of life. We hope these reviews will help urologists to counsel their patients with regards to decision-making in the management of early prostate cancer.

Expanded Prostate Cancer Index Composite for Clinical Practice: Development and Validation of a Practical Health Related Quality of Life Instrument for Use in the Routine Clinical Care of Patients With Prostate Cancer

Longitudinal Changes in U.S. Parameters of Neurovascular Bundles Suggest Mechanism for Radiation-Induced Erectile Dysfunction

Baseline Functional Status May Predict Decisional Regret Following Robotic Prostatectomy

Quality of Life in Patients With Localized Prostate Cancer: High-Dose Rate Brachytherapy Versus Laparoscopic Prostatectomy

To examine the effect of changes in quality of life (QoL) and levels of sexual function on decisional regret after surgical treatment of localized prostate cancer. Patients who decided to have a radical prostatectomy (RP) were assessed for health-related QoL using the general European Organization for Research and Treatment of Cancer C30 instrument and disease-specific prostate cancer module, and sexual function using the abbreviated International Index of Erectile Function-5 before and 1 year after RP. Decision control was measured before RP, and decisional regret 1 year afterward, using measures mailed to participants 1 year after treatment. Of 130 respondents (mean age 62 years), 4% expressed regret over their decision to have surgery. Physical and social functioning, and finances, were compromised, while emotional functioning and treatment-related symptoms improved by 1 year. Higher levels of decisional regret were correlated with decreases in role and social functioning, increased pain and financial difficulty (all P < 0.01). Sexual function was decreased (P < 0.001) after treatment. Men reported feeling less masculine, having less sexual enjoyment, difficulty in getting and maintaining an erection, and discomfort when being sexually intimate after surgery. Mean scores of decisional regret were similar among patients who reported assuming either active (84%) or collaborative (11%) roles in treatment decision-making. Men who assumed a passive role reported the most variability and highest scores on decision regret. Few men regretted having RP at 1 year after treatment, even though some QoL functions and domains were significantly affected. Ongoing assessment of the effect of surgical treatment on sexual function, sexuality and masculinity certainly deserves further exploration with this group of cancer survivors.

Preoperative Erectile Function Represents a Significant Predictor of Postoperative Urinary Continence Recovery in Patients Treated With Bilateral Nerve Sparing Radical Prostatectomy

Health Related Quality of Life for Men Treated for Localized Prostate Cancer With Long-Term Followup

RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER PROVIDES DURABLE CANCER CONTROL WITH EXCELLENT QUALITY OF LIFE: A STRUCTURED DEBATE

LIFE AFTER RADICAL PROSTATECTOMY: A LONGITUDINAL STUDY

Men with Low Preoperative Sexual Function May Benefit from Nerve Sparing Radical Prostatectomy

Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Objective.The aim of this study was to determine whether deferred radical therapy for low-risk prostate cancer has an additionally unfavourable effect on quality of life (QoL). Substantial numbers of patients on active surveillance (AS) are eventually treated. Material and methods. Prostate cancer patients treated with robot-assisted radical prostatectomy (RARP) in the NCI-AvL (Amsterdam, The Netherlands) received systematic QoL questionnaires preoperatively and postoperatively. Questionnaires included the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core Module and Prostate Module (EORTC-QLQ-C30 and EORTC-QLQ-PR25), International Index of Erectile Function-15 (IIEF-15) and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). Patients with low-risk prostate cancer who received RARP after an initial period of AS (AS-RARP group) were compared with similar patients who primarily elected surgery (direct-RARP group). Results.The AS-RARP group included 29 patients who received RARP after a median period of 15.4 months of AS (range 3.0–18.8 months). Main reasons for deferred radical therapy were repeat biopsy risk reclassification (45%) and prostate-specific antigen progression (38%). The direct-RARP group included 363 patients treated after 3.3 months (range 0.1–45.5 months). RARP generally resulted in clinically relevant unfavourable changes on different QoL domains in both groups. Preoperatively the AS-RARP group showed more favourable scores on multiple QoL domains (physical functioning, p = 0.004; role functioning, p = 0.001; global health, p = 0.043; sexual activity, p = 0.001; sexual functioning, p = 0.029; IIEF-15, p = 0.042). Postoperatively, most of these more favourable scores in the AS-RARP group had changed to scores similar to the direct-RARP group, except for IIEF-15 (p = 0.027) and urinary symptoms (p = 0.001). When using a 12 month treatment delay threshold, a similar but less distinct effect was seen. Conclusions.Patients with low-risk prostate cancer who choose AS have more favourable preoperative QoL scores than patients who primarily elect radical prostatectomy, but these groups show similar postoperative QoL scores.

SILDENAFIL CITRATE AFTER RADICAL RETROPUBIC PROSTATECTOMY

93 Background: Few studies have reported long term quality of life after primary treatment for localized prostate cancer. The objective of this study was report 10 year sexual and urinary quality of life data for men undergoing various treatments in the Cancer of the Prostate Strategy and Research Endeavor database. Methods: Men who have been treated for localized prostate cancer and have baseline and follow up quality of life date made up the study cohort. Primary treatment modalities included radical prostatectomy (RP), external beam radiotherapy (EBRT), brachytherapy (BT), cryotherapy (CT), primary androgen deprivation therapy (ADT), and active surveillance/ watchful waiting (AS/WW). Sexual and urinary quality of life were assessed by the validated UCLA Prostate Cancer Index and measured on a scale from 0-100. Mixed model repeated measures analysis was used to assess the association between primary treatment modality and long term urinary and sexual quality of life. Results: 3, 772 men made up the study cohort. Among all men being treated for prostate cancer the mean urinary function score was 92 at baseline, 76 at 1 year, 81 at 5 years and 77 at 10 years. Urinary bother scores were 84 at baseline, 71 at 1 year, 82 at 5 years, and 78 at 10 years. With respect to sexual function the mean score was 49 at baseline, 23 at 1 year, 29 at 5 years, and 24 at 10 years. Finally, the mean sexual bother score was 59 at baseline, 37 at 1 year, 46 at 5 years, and 47 at 10 years. With respect to quality of life by primary treatment modality most treatments showed a similar pattern of decreased scores in the first year followed by an increased in the following two years and a plateau up to the 10 year mark. EBRT and BT showed a longer decline in sexual and urinary function post treatment while RP scores plateau after 3 years. Conclusions: Men undergoing primary treatment for localized prostate cancer experience declines in sexual and urinary function and bother in the first year which improves after 3 years and plateaus up to 10 years.