Long-term utilities after localized prostate cancer treatment: Is treatment-related dysfunction important?

Abstract

6546 Background: While sexual, bowel, and urinary dysfunction caused by localized prostate cancer (CaP) treatments is well described, it is unclear if and/or how this dysfunction affects patients' valuation of their global health. This is the largest report of long- term utilities after CaP treatment, which reflect not only patient symptoms, but also the value or preference a patient places on his health state. Methods: Using validated symptom indices and the Short Form 36 (SF-36), we prospectively collected data from 409 patients at baseline and at fixed intervals after surgical or radiation treatment. Numerical index scores were translated into good, intermediate, and poor levels of function as described previously, and SF-6D utilities were derived from 11 items of the SF-36. Univariable and multivariable regression models were used to assess whether long-term functional outcomes, patient age, and comorbid disease were significantly associated with 36-month utilities. Results: Mean 36-month SF-6D is 0.80 (range 0.50–1.0, standard deviation 0.10). Patients with different long- term sexual, bowel, and urinary functional outcomes had significantly different 36-month utilities (Table). Age (p=.006) and baseline index of comorbid disease (ICED, p<.001) were also significant on univariable analysis. Multivariable analysis showed that urinary incontinence (p<.001) and bowel dysfunction (p=.01) were significantly correlated with 36-month utilities. Baseline ICED was of borderline significance (p=.07). Conclusions: Prostate cancer patients after localized treatment rate their health states highly, but treatment-related dysfunction, especially urinary incontinence and bowel dysfunction, are associated with utility decrements comparable to those from cataracts or heart disease. Our study provides further evidence that dysfunction from early prostate cancer treatment can meaningfully affect patients' long-term health. Mean Utilities for Patients with Different Levels of Function Sexual Function Bowel Function Urinary Incontinence Urinary Obstruction/Irritation Good 0.85 0.83 0.82 0.83 Intermediate 0.82 0.79 0.77 0.79 Poor 0.79 0.75 0.67 0.75 p=.003 (ANOVA) p<.001 p<.001 p<.001 No significant financial relationships to disclose.