Quality of Life After Primary Treatment for Localized Prostate Cancer: Long-term Considerations

Abstract

Patients with localized prostate cancer have a multitude of options to weigh in considering treatment of their disease, including surgery with radical prostatectomy (RP) via open or robotic techniques, radiation therapy (RT) with either external-beam RT (EBRT) or brachytherapy (BT), and active surveillance (AS). With the oncologic efficacy of these approaches being reasonably similar, the majority of patients focus on the side-effect profiles of these treatment options. A great body of work has elucidated the healthrelated quality of life (HRQOL) outcomes of different treatments over the past decade, with most conclusions drawn at 2 yr after therapy; however, an information gap remains regarding longer term outcomes (5–10 yr after treatment) [1,2]. In addition, with the increased prevalence of AS, more studies are describing the HRQOL outcomes associated with this approach. In this issue of European Urology, Punnen et al [3] present the long-term HRQOL outcomes from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry, which includes patients treated by all previously mentioned approaches with follow-up of up to 10 yr. Punnen et al found that at 5 and 10 yr after treatment, there was no difference in sexual HRQOL outcome among RP, BT, and EBRT, whereas patients undergoing AS had better sexual HRQOL than treated patients [3]. These findings are consistent with the notion that radiation leads to neurovascular injury that accumulates over time, whereas surgery is associated with variable functional recovery and improvements over time following the initial postsurgical decline. Sexual HRQOL outcome after prostatectomy was previously found to be similar to that after RT combined with hormonal therapy and worse than that