Long-term Prostate Cancer Survivors Research Articles

2057P Prevalence of frailty in long-term prostate cancer survivors after radical prostatectomy and its association with quality of life and emotional health

2057P Prevalence of frailty in long-term prostate cancer survivors after radical prostatectomy and its association with quality of life and emotional health

Prevalence and determinants of decision regret in long-term prostate cancer survivors following radical prostatectomy

BackgroundPatients with localized prostate cancer (PC) are faced with a wide spectrum of therapeutic options at initial diagnosis. Following radical prostatectomy (RP), PC patients may experience regret regarding their initial choice of treatment, especially when oncological and functional outcomes are poor. Impacts of psychosocial factors on decision regret, especially after long-term follow-up, are not well understood. This study aimed to investigate the prevalence and determinants of decision regret in long-term PC survivors following RP.Methods3408 PC survivors (mean age 78.8 years, SD = 6.5) from the multicenter German Familial PC Database returned questionnaires after an average of 16.5 (SD = 3.8) years following RP. The outcome of decision regret concerning the initial choice of RP was assessed with one item from the Decision Regret Scale. Health-related quality of life (HRQoL), PC-anxiety, PSA-anxiety, as well as anxiety and depressive symptoms were considered for independent association with decision regret via multivariable logistic regression.Results10.9% (373/3408) of PC survivors reported decision regret. Organ-confined disease at RP (OR 1.39, 95%CI 1.02–1.91), biochemical recurrence (OR 1.34, 1.00-1.80), low HRQoL (OR 1.69,1.28–2.24), depressive symptoms (OR 2.32, 1.52–3.53), and prevalent PSA anxiety (OR 1.88,1.17–3.01) were significantly associated with increased risk of decision regret. Shared decision-making reduced the odds of decision regret by 40% (OR 0.59, 0.41–0.86).ConclusionsPC survivors may experience decision regret even after 16 years following RP. Promoting shared decision-making in light of both established and novel, potentially less invasive treatments at initial diagnosis may help mitigate long-term regret. Awareness regarding patients showing depressive symptoms or PSA anxiety should be encouraged to identify patients at risk of decision regret in need of additional psychological support.

Relative Burden of Cancer and Noncancer Mortality Among Long-Term Survivors of Breast, Prostate, and Colorectal Cancer in the US

Improvements in cancer outcomes have led to a need to better understand long-term oncologic and nononcologic outcomes and quantify cancer-specific vs noncancer-specific mortality risks among long-term survivors. To assess absolute and relative cancer-specific vs noncancer-specific mortality rates among long-term survivors of cancer, as well as associated risk factors. This cohort study included 627 702 patients in the Surveillance, Epidemiology, and End Results cancer registry with breast, prostate, or colorectal cancer who received a diagnosis between January 1, 2003, and December 31, 2014, who received definitive treatment for localized disease and who were alive 5 years after their initial diagnosis (ie, long-term survivors of cancer). Statistical analysis was conducted from November 2022 to January 2023. Survival time ratios (TRs) were calculated using accelerated failure time models, and the primary outcome of interest examined was death from index cancer vs alternative (nonindex cancer) mortality across breast, prostate, colon, and rectal cancer cohorts. Secondary outcomes included subgroup mortality in cancer-specific risk groups, categorized based on prognostic factors, and proportion of deaths due to cancer-specific vs noncancer-specific causes. Independent variables included age, sex, race and ethnicity, income, residence, stage, grade, estrogen receptor status, progesterone receptor status, prostate-specific antigen level, and Gleason score. Follow-up ended in 2019. The study included 627 702 patients (mean [SD] age, 61.1 [12.3] years; 434 848 women [69.3%]): 364 230 with breast cancer, 118 839 with prostate cancer, and 144 633 with colorectal cancer who survived 5 years or more from an initial diagnosis of early-stage cancer. Factors associated with shorter median cancer-specific survival included stage III disease for breast cancer (TR, 0.54; 95% CI, 0.53-0.55) and colorectal cancer (colon: TR, 0.60; 95% CI, 0.58-0.62; rectal: TR, 0.71; 95% CI, 0.69-0.74), as well as a Gleason score of 8 or higher for prostate cancer (TR, 0.61; 95% CI, 0.58-0.63). For all cancer cohorts, patients at low risk had at least a 3-fold higher noncancer-specific mortality compared with cancer-specific mortality at 10 years of diagnosis. Patients at high risk had a higher cumulative incidence of cancer-specific mortality than noncancer-specific mortality in all cancer cohorts except prostate. This study is the first to date to examine competing oncologic and nononcologic risks focusing on long-term adult survivors of cancer. Knowledge of the relative risks facing long-term survivors may help provide pragmatic guidance to patients and clinicians regarding the importance of ongoing primary and oncologic-focused care.

MP67-13 RELATIONSHIP BETWEEN FRAILTY AND MENTAL HEALTH AND QUALITY OF LIFE IN LONG-TERM PROSTATE CANCER SURVIVORS AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP67-13 RELATIONSHIP BETWEEN FRAILTY AND MENTAL HEALTH AND QUALITY OF LIFE IN LONG-TERM PROSTATE CANCER SURVIVORS AFTER RADICAL PROSTATECTOMY Kathleen Herkommer, Valentin Meissner, Lukas Lunger, Kolja Imhof, Matthias Jahnen, Donna Ankerst, Andreas Dinkel, Stefan Schiele, and Juergen Gschwend Kathleen HerkommerKathleen Herkommer More articles by this author , Valentin MeissnerValentin Meissner More articles by this author , Lukas LungerLukas Lunger More articles by this author , Kolja ImhofKolja Imhof More articles by this author , Matthias JahnenMatthias Jahnen More articles by this author , Donna AnkerstDonna Ankerst More articles by this author , Andreas DinkelAndreas Dinkel More articles by this author , Stefan SchieleStefan Schiele More articles by this author , and Juergen GschwendJuergen Gschwend More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Aging-related deficits that eventually manifest as frailty are emerging as an important determinant for mental health and quality of life in older patients with cancer. The objective of the current study was (I) to assess the prevalence of frailty and (II) to elucidate the relationship between frailty and mental health as well as quality of life in long-term prostate cancer survivors after radical prostatectomy. METHODS: 2979 prostate cancer survivors from the multicenter German Familial Prostate Cancer Database were included. Patients completed standardized patient-reported outcome measures on the outcomes of interest frailty (Groningen Frailty indicator), quality of life (EORTC QLQ-C30), and anxiety/depressive symptoms (PHQ-4). Additionally, sociodemographic and clinicopathological factors as well as cancer-related self-perception were assessed. Chi square tests were used to detect differences of selected variables in frail and non-frail patients. RESULTS: The patients’ mean age was 79 years (SD=6.4) and mean time since radical prostatectomy was 18 years (SD=3.7). 33% (985/2979) of the patients were classified as frail. Regarding mental health and quality of life, frail patients reported more often depressive (24% vs. 4.0%; p<0.01) and anxiety (21% vs. 2.0%; p<0.01) symptoms and lower quality of life (mean quality of life score of 50 out of 100 vs. 70 out of 100; p<0.01) compared to non-frail patients. Frail patients were older (81 vs. 79 years; p<0.01), less often partnered (80% vs. 90%; p<0.01), and less often satisfied with their economic situation 96% vs. 99%; p<0.01) compared to non-frail patients. Frail patients had more often a secondary cancer (16% vs 12%; p<0.01), biochemical recurrence since radical prostatectomy (41% vs. 34%; p<0.01), and were more often under current prostate cancer therapy (15% vs. 8.0%; p<0.01). Cancer-related self-perception showed significant differences between frail and non-frail patients (p<0.01). For instance, frail patients perceived themselves more often as “victim” (3.0% vs. 1.4%), whereas non-frail patients favored the term “cancer conqueror” (10% vs. 7.4%). CONCLUSIONS: Prevalence of frailty is high in elderly long-term prostate cancer survivors. The association with poorer mental health and lower quality of life indicates the need for an integrated care approach including further geriatric assessment and possible interventions to improve health outcomes of these patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e948 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kathleen Herkommer More articles by this author Valentin Meissner More articles by this author Lukas Lunger More articles by this author Kolja Imhof More articles by this author Matthias Jahnen More articles by this author Donna Ankerst More articles by this author Andreas Dinkel More articles by this author Stefan Schiele More articles by this author Juergen Gschwend More articles by this author Expand All Advertisement PDF downloadLoading ...

MP61-13 PREVALENCE AND DETERMINANTS OF DECISION REGRET IN LONG-TERM PROSTATE CANCER SURVIVORS FOLLOWING RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP61-13 PREVALENCE AND DETERMINANTS OF DECISION REGRET IN LONG-TERM PROSTATE CANCER SURVIVORS FOLLOWING RADICAL PROSTATECTOMY Kathleen Herkommer, Lukas Lunger, Valentin Meissner, Benedikt Kopp, Andreas Dinkel, Stefan Schiele, Donna Ankerst, and Juergen Gschwend Kathleen HerkommerKathleen Herkommer More articles by this author , Lukas LungerLukas Lunger More articles by this author , Valentin MeissnerValentin Meissner More articles by this author , Benedikt KoppBenedikt Kopp More articles by this author , Andreas DinkelAndreas Dinkel More articles by this author , Stefan SchieleStefan Schiele More articles by this author , Donna AnkerstDonna Ankerst More articles by this author , and Juergen GschwendJuergen Gschwend More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A variety of therapeutic options are available for localized prostate cancer (PC). Choosing the most suitable treatment option can be difficult and requires weighing up against respective side effect profiles. Following radical prostatectomy (RP), PC survivors may experience regret regarding their initial choice of treatment. While long-term impact of functional outcomes on decision regret has been studied extensively, the role of psychosocial factors on decision regret is less understood. The current study aimed to investigate the prevalence and determinants of decision regret in long-term PC survivors following RP. METHODS: A total of 3,408 PC survivors (mean age 78.8±6.5 years, mean time since RP 16.5±3.8 years) from the multicenter German Familial PC Database returned questionnaires. Current decision regret was assessed with one item from the Decision Regret Scale. Validated measures were used to assess treatment decision making, health-related quality of life (HRQoL), PC anxiety, PSA anxiety, general anxiety, and depressive symptoms. Multivariable logistic regression analyses were used to determine variables independently associated with decision regret. RESULTS: Here, 10.9% (373/3408) of PC survivors reported decision regret. Figure 1 depicts the percentage reporting regret by psychological parameters and HRQoL. On multivariable regression, organ-confined disease at RP (OR 1.39, 95%CI: 1.02-1.91), biochemical recurrence (OR 1.34 95%CI: 1.00-1.80), low HRQoL (OR 1.69, 95%CI: 1.28-2.24), depressive symptoms (OR 2.32, 95%CI: 1.52-3.53), and PSA anxiety (OR 1.88, 95%CI: 1.17-3.01) were significantly associated with decision regret. Shared-decision making was associated with a lower risk of regret than passive-decision making. (OR 0.59, 95%CI: 0.41-0.86). CONCLUSIONS: The findings underline that PC survivors may experience decision regret even after 16 years following RP. Promoting shared-decision making may help mitigate long-term regret. Awareness regarding patients showing signs of clinical depression or PSA anxiety should be encouraged to identify patients at risk of decision regret in need of additional support. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e857 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kathleen Herkommer More articles by this author Lukas Lunger More articles by this author Valentin Meissner More articles by this author Benedikt Kopp More articles by this author Andreas Dinkel More articles by this author Stefan Schiele More articles by this author Donna Ankerst More articles by this author Juergen Gschwend More articles by this author Expand All Advertisement PDF downloadLoading ...

Prevalence and determinants of decision regret in long-term prostate cancer survivors following radical prostatectomy

Prevalence and determinants of decision regret in long-term prostate cancer survivors following radical prostatectomy

Treatment decision regret in long-term survivors after radical prostatectomy: a longitudinal study.

To investigate prevalence, course, and predictors of longitudinal decision regret in long-term prostate cancer (PCa) survivors treated by radical prostatectomy (RP). A total of 1003 PCa survivors from the multicentre German Familial PCa Database completed questionnaires on average 7 years after RP in 2007 and at follow-up 13 years later in 2020. Patients completed standardised patient-reported outcome measures on decision regret, decision-making, health-related quality of life, and psychosocial factors. Hierarchical multivariable logistic regression was used to assess predictors of longitudinal decision regret. Decision regret increased significantly over time (9.0% after 6.9 years in 2007 and 12% after 19 years in 2020; P= 0.009). Favourable localised PCa (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.05-3.68), decision regret in 2007 (OR 6.38, 95% CI 3.55-11.47), and a higher depression score (OR 1.37, 95% CI 1.03-1.83) were associated with decision regret in 2020. Shared decision-making (OR 0.55, 95% CI 0.33-0.93) was associated with less decision regret. The findings of the present study underline the perseverance of decision regret in long-term PCa survivors and the definitive need for involving patients in the decision-making process to mitigate regret over the long term.

Health-related quality of life in long-term Caribbean prostate cancer survivors: comparisons with prostate cancer-free men.

Prostate cancer (PCa) and its treatment can impact health-related quality of life (HRQoL). There are few studies of HRQoL in long-term PCa survivors of African ancestry from low- and middle-income countries. We examined the effect of PCa treatment on HRQoL of Jamaican PCa survivors compared with cancer-free controls and explored the effect of demographic and clinical factors on these outcomes. PCa survivors (n = 64) treated with and without ADT along with PCa-free controls (n = 88) from a case-control study of 10years post enrolment. HRQoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life (EORTC-QLQ-C30). Effects of demographic and clinical variables on HRQoL on PCa and type of therapy were evaluated in multivariable linear regression models. HRQoL of PCa survivors (overall and by treatment group) indicated a high quality of life, comparable to PCa-free men. However, ADT-treated survivors had lower physical functioning that was of small clinical relevance compared with those not on ADT. Symptom burden scores of PCa survivors and controls were similar excluding fatigue and dyspnoea which were highest in men on ADT and controls. In multivariable models, PCa was not an important determinant of overall HRQoL, functioning or symptom burdens. Underlying medical conditions and marital status were the main contributors to HRQoL in PCa survivors. PCa cancer status was not an independent determinant of long-term HRQoL in Jamaican men. Interventions addressing social factors and comorbid illnesses could improve HRQOL in long-term PCa survivors.

A Comparison between Patient- and Physician-Reported Late Radiation Toxicity in Long-Term Prostate Cancer Survivors.

Simple SummaryRadiotherapy is widely used as treatment for localized prostate cancer. Due to a high incidence and a good survival after treatment, a large number of prostate cancer survivors are at risk of developing late radiation toxicity. Symptoms may significantly affect quality of life; therefore, the monitoring of toxicities and evaluating their impact are increasingly important matters. Toxicities have always been assessed by physicians, but there is a growing interest in the use of questionnaires to be completed by patients themselves, so-called patient-reported outcome measures. The aim of this study was to compare both outcomes in long-term prostate cancer survivors, and to determine which outcome correlates best with a biological predictor of late radiation toxicity. In symptomatic patients, we found a low agreement; patients assigned greater severity to symptoms than the trial physician assistant did. Neither outcome correlated with the biological predictor. Consideration of both perspectives seems warranted to provide the best care.Patient-reported outcome measures (PROMs) are advocated for the monitoring of toxicity after radiotherapy. However, studies comparing physician- and patient-reported toxicity show low concordance. In this study, we compared physician- and patient-reported toxicity in long-term prostate cancer survivors after radiotherapy, and we determined the correlation with a presumable risk factor for late toxicity: γ-H2AX foci decay ratio (FDR). Patients formerly included in a prospective study were invited to participate in this new study, comprising one questionnaire and one call with a trial physician assistant. Concordance was calculated for seven symptoms. Gamma-H2AX FDRs were determined in ex vivo irradiated lymphocytes in a previous analysis. Associations between FDR and long-term prevalence of toxicity were assessed using univariable logistic regression analyses. The 101 participants had a median follow-up period of 9 years. Outcomes were discordant in 71% of symptomatic patients; in 21%, the physician-assessed toxicity (using CTCAE) was higher, and, in 50%, the patients reported higher toxicity. We did not find a correlation between presence of toxicity at long-term follow-up and FDR. In conclusion, patients assigned greater severity to symptoms than the trial physician assistant did. Consideration of both perspectives may be warranted to provide the best care.

Genetski prediktori radijacione toksičnosti kod pacijenata sa karcinomom prostate

Cancer survivors often face adverse effects of treatment, which have a significant impact on morbidity and mortality. Normal-tissue side effects following radiotherapy (RT), as one of therapeutic modalities, are common and may seriously affect quality of life which is especially important in long-term prostate cancer (PC) survivors. Upgrading in our knowledge in radiation biology have led to the better understanding that genetics plays a significant role in determining a patient's predisposition to developing late RT toxicity, leading to the new field of research called "radiogenomics". With the evolution of DNA sequencing technologies and genomic analysis, radiogenomics made an appearance as a state-of-the-art science in the field of personalized medicine with the goal of detection the genetic determinants RT adverse reactions. A single-nucleotide polymorphism (SNPs) - based assay could be used to predict the risk of RT side effects along with clinical features and treatment factors. Several SNPs have been identified that are associated with late radiation-induced morbidity in PC patients. Most importantly, these SNPs make up genes expressed in the tissues that are likely at the root of these symptoms, including the bladder, rectum, and small intestine, which are most exposed in PC RT. Furthermore, genome-wide association studies are likely to lead to an increasing number of genetic polymorphisms that can predict long-term RT complications. Finally, radiogenomics attempts to predict which PC patients will show radiosensitivity, so that radiation oncologists, as well as surgeons, can change treatment accordingly in order to reduce side effects or increase the RT effectiveness.

Diversity of cancer-related identities in long-term prostate cancer survivors after radical prostatectomy

BackgroundIndividuals affected by cancer need to integrate this experience into their personal biography as their life continues after primary therapy, leading to substantial changes in self-perception. This study identified factors uniquely associated with 5 different cancer-related identities in order to improve the understanding of how self-perception in men affected by prostate cancer is associated with certain clinical and psychosocial characteristics.MethodsIn this cross-sectional study, long-term prostate cancer survivors after radical prostatectomy were asked to choose one of 5 cancer-related identities that described them best. Associations with sociodemographic, clinical, and psychological variables were investigated using multivariable logistic regression.ResultsThree thousand three hundred forty-seven men (mean age 78.1 years) surveyed on average 15.6 years after prostatectomy were included. Most men favored the terms “someone who has had cancer” (43.9%) which was associated with a mild disease course, and “patient” (26.3%) which was associated with ongoing therapy and biochemical disease recurrence. The self-descriptions “cancer survivor” (16.8%), “cancer conqueror” (10.9%) and “victim” (2.1%) were less common. “Cancer survivor” was associated with high perceived disease severity (OR: 1.86 [1.44–2.40]). “Cancer survivor” and “cancer conqueror” were related to high benefit finding (OR: 1.89 [1.48–2.40], OR: 1.46 [1.12–1.89] respectively), and only “cancer conqueror” was associated with high well-being (OR: 1.84 [1.35–2.50]). Identification as “victim” was associated with a positive depression screening and low well-being (OR: 2.22 [1.15–4.31], OR: 0.38 [0.20–0.72] respectively) (all p < 0.05).ConclusionsAlthough long-term survival is common among men affected by PCa, they display a large diversity in cancer-related identities, which are associated with unique clinical and psychological characteristics. These cancer-related identities and their distinctive properties are associated with psychological well-being even after a long follow-up.

P1170 - Fear of cancer recurrence and disease progression in long-term prostate cancer survivors after radical prostatectomy: A longitudinal study

P1170 - Fear of cancer recurrence and disease progression in long-term prostate cancer survivors after radical prostatectomy: A longitudinal study

Health-Related Quality of Life in Very Long-Term Cancer Survivors 14-24 Years Post-Diagnosis Compared to Population Controls: A Population-Based Study.

Simple SummaryLittle is known about the health-related quality of life in very long-term cancer survivors 10 and more years post-diagnosis. Therefore, we compared the health-related quality of life of survivors of breast, colorectal, and prostate cancer (14–24 years post-diagnosis) with that of same-aged non-cancer controls, according to age, sex, and disease status (disease-free vs. stage IV, recurrence, metastasis, or second cancer). We found that the overall global health status/quality of life of cancer survivors more than a decade after diagnosis was slightly higher than that of population controls of the same age, but more symptoms and lower functioning were reported. Differences were small but statistically significant. Results differed by age, sex, and disease status. The findings point out the need for a comprehensive survivorship care program in order to monitor and treat potential late and long-term effects after the diagnosis and treatment of cancer. Survivorship care should be risk-adapted to survivors’ needs according to sociodemographic and clinical factors.(1) Background: Little is known about the health-related quality of life (HRQoL) in very long-term cancer survivors (VLTCS) 10 and more years post-diagnosis. The objective was to compare cancer survivors’ HRQoL 14–24 years post-diagnosis with that of same-aged non-cancer controls, stratified by age, sex, and disease status (disease-free vs. stage IV, recurrence, metastasis, or second cancer). (2) Methods: We recruited 2704 very long-term survivors of breast, colorectal and prostate cancer, and 1765 controls in German multi-regional population-based studies. The HRQoL was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Differences in the HRQoL were estimated with multiple regression, controlling for age, sex (where appropriate), and education. (3) Results: The overall global health status/quality of life of VLTCS more than a decade after diagnosis was slightly higher than that of population controls of the same age, but more symptoms and lower functioning were reported. Differences were small but statistically significant. Results differed by age, sex, and disease status. (4) Conclusions: The findings point out the need for a comprehensive survivorship care program in order to monitor and treat potential late and long-term effects after the diagnosis and treatment of cancer. Survivorship care should be risk-adapted to survivors’ needs according to sociodemographic and clinical factors.

Identifying classes of the pain, fatigue, and depression symptom cluster in long-term prostate cancer survivors\u2014results from the multi-regional Prostate Cancer Survivorship Study in Switzerland (PROCAS)

PurposeAside from urological and sexual problems, long-term (≥5 years after initial diagnosis) prostate cancer (PC) survivors might suffer from pain, fatigue, and depression. These concurrent symptoms can form a cluster. In this study, we aimed to investigate classes of this symptom cluster in long-term PC survivors, to classify PC survivors accordingly, and to explore associations between classes of this cluster and health-related quality of life (HRQoL).MethodsSix hundred fifty-three stage T1-T3N0M0 survivors were identified from the Prostate Cancer Survivorship in Switzerland (PROCAS) study. Fatigue was assessed with the EORTC QLQ-FA12, depressive symptoms with the MHI-5, and pain with the EORTC QLQ-C30 questionnaire. Latent class analysis was used to derive cluster classes. Factors associated with the derived classes were determined using multinomial logistic regression analysis.ResultsThree classes were identified: class 1 (61.4%) – “low pain, low physical and emotional fatigue, moderate depressive symptoms”; class 2 (15.1%) – “low physical fatigue and pain, moderate emotional fatigue, high depressive symptoms”; class 3 (23.5%) – high scores for all symptoms. Survivors in classes 2 and 3 were more likely to be physically inactive, report a history of depression or some other specific comorbidity, be treated with radiation therapy, and have worse HRQoL outcomes compared to class 1.ConclusionThree distinct classes of the pain, fatigue, and depression cluster were identified, which are associated with treatment, comorbidities, lifestyle factors, and HRQoL outcomes. Improving classification of PC survivors according to severity of multiple symptoms could assist in developing interventions tailored to survivors’ needs.

Benefit finding in long-term prostate cancer survivors

PurposeBenefit finding (BF) represents possible positive changes that people may experience after cancer diagnosis and treatment and has proven to be valuable to the psychological outcome. Knowledge of such beneficial consequences of prostate cancer (PCa) is limited in long-term survivors (> 5 years). Thus, the present study investigated the occurrence of benefit finding (BF) and its determinants in a large sample of (very-) long-term PCa survivors.MethodsBF was assessed in 4252 PCa survivors from the German database “Familial Prostate Cancer” using the German version of the Benefit Finding Scale (BFS). Associations between BF and sociodemographic, clinical, and psychosocial (e.g., depressive and anxiety symptoms and perceived severity of the disease experience) variables were analyzed using hierarchical multiple linear regression analysis.ResultsMean age at survey was 77.4 years (SD = 6.2) after a mean follow-up of 14.8 years (SD = 3.8). Mean BFS score was 3.14 (SD = 1.0); the prevalence of moderate-to-high BF (score ≥ 3) was 59.7%. Younger age at diagnosis, lower educational level, and higher perceived severity of the disease experience were predictive of BF. Objective disease severity or family history of PCa was not uniquely associated with BF.ConclusionsBF occurs in older, (very-) long-term PCa survivors. Our findings suggest that the self-asserted severity of the disease experience in a patient’s biography is linked to BF in the survivorship course above all tangible sociodemographic and clinical factors.Implications for cancer survivorsPCa survivors may express BF regardless of clinical disease severity. Treating urologists should consider inquiring BF to enrich a patient’s cancer narrative.

Evaluation of long-term living conditions in patients treated for localised prostate cancer.

To evaluate the evolution of living conditions (LC) in long-term survivors of localised prostate cancer 10years after treatment compared with those of a same-age control group from the general population. Two hundred and eighty-seven patients diagnosed with prostate cancer in 2001 were selected in 11 French cancer registries. They were matched with controls randomly selected for age and residency. Both patients and controls completed a self-administered LC questionnaire concerning their familial, social and professional life, and general and specific quality of life (QoL) and anxiety and depression questionnaires. Compared with controls, patients reported more sexual modifications (p<.0001), but without any difference in marital status. Patients' circle of friends was more stable than that of the controls (91% vs. 63%; p<.0001) and patients reported fewer friendship modifications than controls (p<.0006). Their professional and physical activities were also preserved. They reported more anxiolytic intake (p=.002) but did not consult their general practitioner more often. Type of specialist consulted differed in the two groups. Patients treated for localised prostate cancer had the same living conditions as men of the same age. Their social life was satisfying on the whole, albeit they reported more sexual difficulties than their counterparts.

Health-related quality of life in long-term prostate cancer survivors after nerve-sparing and non-nerve-sparing radical prostatectomy-Results from the multiregional PROCAS study.

BackgroundNerve‐sparing (NS) surgery was developed to improve postoperative sexual and potentially urological outcomes after radical prostatectomy (RP). However, it is largely unknown how NSRP affects health‐related quality of life (HRQoL) including urinary and sexual outcomes in prostate cancer (PC) survivors 5‐10 years after diagnosis in comparison with Non‐NSRP.MethodsThe study population included 382 stage pT2‐T3N0M0 PC survivors 5‐10 years post diagnosis, who were identified from the multiregional Prostate Cancer Survivorship in Switzerland (PROCAS) study. Briefly, in 2017/2018, PC survivors were identified via six population‐based cancer registries based in both German‐ and French‐speaking Switzerland. HRQoL and PC‐specific symptom burden was assessed using the EORTC QLQ‐C30 and EORTC QLQ‐PR25 questionnaires. Differences in HRQoL outcomes between survivors treated with NSRP (uni‐ & bilateral) and Non‐NSRP were analyzed with multivariable linear regression adjusted for age, years since diagnosis, cancer stage, comorbidities at diagnosis, and further therapies, if appropriate. Multiple imputation was performed to minimize the bias due to missing data.ResultsFive to ten years after diagnosis, PC survivors treated with NSRP and Non‐NSRP reported similar symptom burden and comparable HRQoL function scores. The only significant differences were reported for sexual activity, whereas PC survivors who underwent NSRP reported statistically significant (P = .031) higher sexual activity than those on Non‐NSRP. NSRP and Non‐NSRP reported similar scores for urinary symptoms and all other HRQoL outcomes.ConclusionsOur results support nerve‐sparing techniques as an option to improve postoperative sexual, but not urinary outcomes after RP in long‐term PC survivors.

Incidence of subsequent primary cancers and radiation-induced subsequent primary cancers after low dose-rate brachytherapy monotherapy for prostate cancer in long-term follow-up

BackgroundAs aging is the most significant risk factor for cancer development, long-term prostate cancer (PCa) survivors have an evident risk of developing subsequent primary cancers (SPCs). Radiotherapy itself is an additional risk factor for cancer development and the SPCs appearing beyond 5 years after radiotherapy in the original treatment field can be considered as radiation-induced subsequent primary cancers (RISPCs).MethodsDuring the years 1999-2008, 241 patients with localized PCa who underwent low dose-rate brachytherapy (LDR-BT) with I125 and were followed-up in Kuopio University Hospital, were included in this study. In this study the incidences and types of SPCs and RISPCs with a very long follow-up time after LDR-BT were evaluated.ResultsDuring the median follow-up time of 11.4 years, a total of 34 (14.1%) patients developed a metachronous SPC. The most abundant SPCs were lung and colorectal cancers, each diagnosed in six patients (16.7% out of all SPCs). The crude incidence rate of RISPC was 1.7% (n = 4). Half of the SPC cases (50%) were diagnosed during the latter half of the follow-up time as the risk to develop an SPC continued throughout the whole follow-up time with the actuarial 10-year SPC rate of 7.0%. The crude death rates due to metachronous out-of-field SPCs and RISPCs were 50 and 50%, respectively.ConclusionThe crude rate of SPC was in line with previously published data and the incidence of RISPC was very low. These results support the role of LDR-BT as a safe treatment option for patients with localized PCa.

Prostatic irradiation-induced sexual dysfunction: A review and multidisciplinary guide to management in the radical radiotherapy era (Part II on Urological Management).

Prostate cancer is the most common malignancy in men and the second leading cause of cancer-related death in men. Radiotherapy is a curative option that is administered via external beam radiation, brachytherapy, or in combination. Sexual dysfunction is a common toxicity following radiotherapy, similar to men undergoing radical prostatectomy, but the etiology is different. The pathophysiology of radiation-induced sexual dysfunction is multi-factorial, and the toxicity is a major cause of impaired quality of life among long-term prostate cancer survivors. Management of a patient's sexual function during and after radiotherapy requires multidisciplinary coordination of care between radiation oncology, urology, psychiatry, pharmacy, and dermatology. This review provides a framework for clinicians to better understand prostatic radiotherapy-induced sexual dysfunction diagnosis, evaluation, and a patient-centered approach to toxicity preventive strategies and management.

Cost-Effectiveness Analysis of Supervised Exercise Training in Men with Prostate Cancer Previously Treated with Radiation Therapy and Androgen-Deprivation Therapy.

Exercise for prostate cancer (PCa) survivors has been shown to be effective in addressing metabolic function and associated co-morbidities, as well as sarcopenia and significant functional impairment resulting from long-term androgen deprivation. Evidence on the cost-effectiveness of exercise interventions for PCa, however, is lacking, thus the aim of this study was to determine the cost-effectiveness of a supervised exercise intervention for long-term PCa survivors who previously received radiation therapy and androgen-deprivation therapy. Cost-effectiveness analysis from an Australian healthcare-payer perspective was conducted using patient-level data from a multicentre randomised controlled trial (RCT) of supervised exercise training (resistance and aerobic) compared to receiving printed exercise material and a recommendation to exercise in long-term PCa survivors (> 5years post-diagnosis). Analysis was undertaken for the 6-month supervised exercise portion of the intervention, which involved 100 men aged between 62 and 85years, 50 in each arm. The primary outcome was cost per quality-adjusted life-years (QALYs). A 6-month supervised exercise intervention for PCa survivors resulted in an incremental cost-effectiveness ratio of AU$64,235 (2018 AUD) at an incremental cost of AU$546 per person and a QALY gain of 0.0085. At a willingness-to-pay of AU$50,000, the probability that the intervention is cost-effective was 41%. Sensitivity analysis showed that maintenance of benefits via a 6-month home-based intervention, immediately following the supervised intervention, lowered the cost per QALY gained to AU$32,051. This is the first cost-effectiveness analysis of exercise for PCa survivors. The intervention was effective, but unlikely to be cost-effective at the generally accepted willingness-to-pay of AU$50,000 per QALY. It is likely that evidence to support cost savings from post-intervention outcomes would reveal greater benefits and contribute to a more comprehensive cost-effectiveness analysis. Future RCTs should incorporate longer follow-up durations and collection of data to support modelling to capture future health benefits. Measures of quality of life or utility more sensitive to the impact of physical activity would also improve future economic evaluations.