Life after prostate cancer diagnosis: One step beyond.

Abstract

40 Background: Prostate cancer (PCa) outcome studies are frequently restricted to specific disease stage or treatments. Interpretation may be restricted through lack of population control data & selection bias. We report a whole population evaluation of health-related quality of life (HRQL) following diagnosis of PCa compared to a general population (GenPop) cohort. Methods: Cross-sectional postal survey of all men diagnosed with PCa in the UK 18-42 months earlier. Measures of generic HRQL (EQ-5D) and PCa specific outcomes (EPIC-26 & interventions for erectile dysfunction), as defined in ICHOM minimum dataset, were utilized. Comparable GenPop data was collected from men never diagnosed with PCa in Northern Ireland. Results: 35,823 PCa survivors responded (60.8% response rate), median age 71, and 2,995 from the GenPop (30%). Overall HRQL was slightly lower in the PCa men than the GenPop, this difference was significant only in stage 4 disease. Men with PCa were less likely to report problems in individual EQ5D domains than men in the GenPop (62.0% vs. 68.8%). Both populations were most likely to report pain/discomfort, this was lower in PCa men than the GenPop (42.1% vs. 60.8%). Problems increased with age in all domains, with the exception of anxiety/depression. Men generally reported good function on EPIC-26; however PCa survivors reported poorer sexual function (78.9% vs 48%) except in the oldest. Medications/devices/services to aid or improve erections were offered to 45.4%, 26.0% & 16.9% respectively (and considered helpful by 14.7%, 7.5% & 3.2%). Men with PCa reported more problems with urinary leakage (13.1% vs. 7.1%), particularly after surgery. Hormonal symptoms were linked with receiving Androgen Deprivation Therapy and, to a lesser extent, external beam radiation. Conclusions: 18-42 months following diagnosis of PCa significant sexual and urinary morbidity is experienced relative to the GenPop. Specialist support for sexual dysfunction is not always offered. With the exception of men with stage 4 disease, overall HRQL is only mildly reduced. Funding The Life After Prostate Cancer Diagnosis study was funded by the Movember Foundation, in partnership with Prostate Cancer UK, as part of the Prostate Cancer Outcomes programme, grant number BO26/MO.