MP15-08 QUALITY OF LIFE FOLLOWING FOCAL THERAPY, ACTIVE SURVEILLANCE AND ROBOTIC PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2014MP15-08 QUALITY OF LIFE FOLLOWING FOCAL THERAPY, ACTIVE SURVEILLANCE AND ROBOTIC PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER Alyssa Louis, Stacy Rush, Shabbir Alibhai, Andrew Matthew, Robin Kalnin, Michael Nesbitt, Richard Walker, Manjula Maganti, Antonio Finelli, Neil Fleshner, Michael Jewett, Alexandre Zlotta, Girish Kulkarni, Robert Hamilton, and John Trachtenberg Alyssa LouisAlyssa Louis More articles by this author , Stacy RushStacy Rush More articles by this author , Shabbir AlibhaiShabbir Alibhai More articles by this author , Andrew MatthewAndrew Matthew More articles by this author , Robin KalninRobin Kalnin More articles by this author , Michael NesbittMichael Nesbitt More articles by this author , Richard WalkerRichard Walker More articles by this author , Manjula MagantiManjula Maganti More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Neil FleshnerNeil Fleshner More articles by this author , Michael JewettMichael Jewett More articles by this author , Alexandre ZlottaAlexandre Zlotta More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , Robert HamiltonRobert Hamilton More articles by this author , and John TrachtenbergJohn Trachtenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.561AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robot assisted radical prostatectomy (RARP) has rapidly become the standard of care for localized prostate cancer when active treatment is favored over active surveillance (AS). Recently, ablation of the index lesion with focal therapy (FT) has been developed in an attempt to reduce surgical morbidity. Here we compare these three contemporary techniques of cancer control in low volume, low and intermediate risk localized prostate cancers to evaluate health related quality of life (HRQoL) outcomes. METHODS We analyzed records of men treated with RARP, FT or AS for localized prostate cancer at the University Health Network between 2006-2012. Clinical and demographic variables and HRQoL data were collected pre intervention and sequentially thereafter with the Patient Oriented Prostate Utility Scale (PORPUS), the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS). Treatment groups were propensity-matched for important predictors of HRQoL. Our primary outcome was HRQoL at one year after treatment or date of enrolment to AS. RESULTS Prior to matching, there were 367 RARP, 52 FT and 504 AS patients. The groups differed in age, disease risk, comorbidity, ethnicity, baseline IPSS, and baseline PORPUS (p<0.05). On univariate analysis, significant differences were detected in PORPUS, IIEF and IPSS, with AS and FT showing improved outcomes over RARP at one year (p<0.05). On multivariable analysis, significantly lower HRQoL was associated with RARP, older age and lower baseline PORPUS (p<0.05). After matching for age, disease risk, and baseline HRQoL, 41 AS, and 44 RARP patients were compared 41 and 44 FT patients respectively. No statistically significant differences were detected between the 3 groups in IIEF, IPSS or PORPUS at one year. CONCLUSIONS These results suggest that patient selection bias may contribute to HRQoL outcomes to a greater degree than treatment strategy. When matched for baseline differences, we found no statistically significant differences in overall HRQoL, erectile function, and prostate symptomatology at one year after treatment, however this result may be confounded by small sample size and warrants validation with more individuals. Focal Therapy n=41 Active Surveillance n=41 One year IIEF (n=19) 20.4 ± 4.6 20.0 ± 5.1 p=0.78 One year IPSS (n=21) 7.9 ± 6 7.2 ± 5.3 p=0.93 One year PORPUS Psychometric (n=22) 87.9 ± 10.2 84.7 ± 11.4 p=0.76 Focal Therapy n=44 Robot Assisted Radical Prostatectomy n=44 One year IIEF (n=20) 20.3 ± 4.5 11 ± 5.8 p=0.06 One year IPSS (n=21) 7.9 ± 6 4.8 ± 3.6 p=0.65 One year PORPUS Psychometric (n=23) 88.1 ± 10 80.2 ± 10.4 p=0.2 Quality of life comparisons between groups matched for age, disease risk, baseline IIEF5, baseline IPSS, baseline PORPUS one year after treatment or enrollment to active surveillance. IIEF5; International Index of Erectile Function 5-item questionnaire. IPSS; International Prostate Symptom Score. PORPUS; Patient Oriented Prostate Utility Score, Psychometric measure. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e148 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alyssa Louis More articles by this author Stacy Rush More articles by this author Shabbir Alibhai More articles by this author Andrew Matthew More articles by this author Robin Kalnin More articles by this author Michael Nesbitt More articles by this author Richard Walker More articles by this author Manjula Maganti More articles by this author Antonio Finelli More articles by this author Neil Fleshner More articles by this author Michael Jewett More articles by this author Alexandre Zlotta More articles by this author Girish Kulkarni More articles by this author Robert Hamilton More articles by this author John Trachtenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...