Abstract
BackgroundThis study describes and compares health-related quality of life (HRQOL) of prostate cancer patients who received either radical prostatectomy (nerve-sparing, nsRP, or non-nerve-sparing, nnsRP) or radiotherapy (external RT, brachytherapy, or both combined) for treatment of localised prostate cancer.MethodsThe prospective, multicenter cohort study included 529 patients. Questionnaires included the IIEF, QLQ-C30, and PORPUS-P. Data were collected before (baseline), three, six, twelve, and twenty-four months after treatment. Differences between groups’ baseline characteristics were assessed; changes over time were analysed with generalised estimating equations (GEE). Missing values were treated with multiple imputation. Further, scores at baseline and end of follow-up were compared to German reference data.ResultsThe typical time trend was a decrease of average HRQOL three months after treatment followed by (partial) recovery. RP patients experienced considerable impairment in sexual functioning. The covariate-adjusted GEE identified a significant - but not clinically relevant - treatment effect for diarrhoea (b = 7.0 for RT, p = 0.006) and PORPUS-P (b = 2.3 for nsRP, b = 2.2 for RT, p = 0.045) compared to the reference nnsRP. Most of the HRQOL scores were comparable to German norm values.ConclusionsFindings from previous research were reproduced in a specific setting of a patient cohort in the German health care system. According to the principle of evidence-based medicine, this strengthens the messages regarding treatment in prostate cancer and its impacts on patients’ health-related quality of life. After adjustment for baseline HRQOL and other covariates, RT patients reported increased symptoms of diarrhoea, and nnsRP patients decreased prostate-specific HRQOL. RP patients experienced considerable impairment in sexual functioning. These differences should be taken into account by physicians when choosing the best therapy for a patient.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0025-6) contains supplementary material, which is available to authorized users.
Highlights
This study describes and compares health-related quality of life (HRQOL) of prostate cancer patients who received either radical prostatectomy or radiotherapy for treatment of localised prostate cancer
ProCaSP was aimed at evaluating HRQOL outcomes of patients with localised prostate cancer treated with either radical prostatectomy or radiotherapy
More than half of those patients treated with RT, where information on pre-baseline androgen deprivation therapy was available, received androgen deprivation therapy (ADT) (52%)
Summary
This study describes and compares health-related quality of life (HRQOL) of prostate cancer patients who received either radical prostatectomy (nerve-sparing, nsRP, or non-nerve-sparing, nnsRP) or radiotherapy (external RT, brachytherapy, or both combined) for treatment of localised prostate cancer. As every screening test, including the PSA test, aims to detect occult cancers at an early stage, one can assume that a relevant proportion of screening detected prostate cancers would not have become symptomatic. Eisemann et al BMC Urology (2015) 15:28 during life time and can be regarded as overdiagnosis. In these patients cancer treatment may have no benefit but may result in treatment associated morbidity [7]. Because of the favourable prognosis of early stage tumours and because of treatment morbidity, outcomes other than ‘survival’ are increasingly important [9]
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