Patient-Oriented Prostate Utility Scale Research Articles

Health Related Quality of Life of Prostate Cancer Patients: Assessment Using the Short Form 12 Health Survey and Patient Oriented Prostate Utility Scale

Health Related Quality of Life of Prostate Cancer Patients: Assessment Using the Short Form 12 Health Survey and Patient Oriented Prostate Utility Scale

Mapping the Patient-Oriented Prostate Utility Scale From the Expanded Prostate Cancer Index Composite and the Short-Form Health Surveys

ObjectivesThis study aimed to develop mapping algorithms from the Expanded Prostate Cancer Index Composite (EPIC) and the Short-Form (SF) Health Surveys to the Patient-Oriented Prostate Utility Scale (PORPUS), an econometric instrument specifically developed for patients with prostate cancer. MethodsData were drawn from 2 cohorts concurrently administering PORPUS, EPIC-50, and SF-36v2. The development cohort included patients who had received a diagnosis of localized or locally advanced prostate cancer from 2017 to 2019. The validation cohort included men who had received a diagnosis of localized prostate cancer from 2014 to 2016. Linear regression models were constructed with ln(1 − PORPUS utility) as the dependent variable and scores from the original and brief versions of the EPIC and SF as independent variables. The predictive capacity of mapping models constructed with all possible combinations of these 2 instruments was assessed through the proportion of variance explained (R2) and the agreement between predicted and observed values. Validation was based on the comparison between estimated and observed utility values in the validation cohort. ResultsModels constructed with EPIC-50 with and without SF yielded the highest predictive capacity (R2 = 0.884, 0.871, and 0.842) in comparison with models constructed with EPIC-26 (R2 = 0.844, 0.827, and 0.776). The intraclass correlation coefficient was excellent in the 4 models (>0.9) with EPIC and SF. In the validation cohort, predicted PORPUS utilities were slightly higher than those observed, but differences were not statistically significant. ConclusionsMapping algorithms from both the original and the abbreviated versions of the EPIC and the SF Health Surveys allow estimating PORPUS utilities for economic evaluations with cost-utility analyses in patients with prostate cancer.

Associations Between Physical Activity, Quality Of Life And Emotional Well-being During Active Surveillance For Prostate Cancer

PURPOSE: The purpose of this retrospective longitudinal study was to examine the association between post-diagnosis physical activity (PA), and the change in quality of life (QoL) and emotional well-being over time in men on active surveillance (AS) for low-risk prostate cancer. METHODS: Our analysis included 630 participants from AS initiation until AS discontinuation or loss to follow up. A modified Godin Leisure-Time Exercise Questionnaire was used to measure post-diagnosis PA in metabolic equivalent-minutes per week (MET-min/wk). Participants were categorized based on their PA levels: inactive (<210 MET-min/wk), insufficiently active (210-499 MET-min/wk), active (500-1000 MET-min/wk), and highly active (>1000 MET-min/wk). QoL and emotional well-being were assessed by the Patient-Oriented Prostate Utility Scale. The association between post-diagnosis PA (independent variable) and QoL (dependent variable) was assessed using generalized estimated equations (GEE). GEEs were also used to determine the association between PA (independent variable) and emotional well-being (dependent variable). All models adjusted for participant’s age. RESULTS: Compared to inactive participants, active (&#946;1.14; 95%CI= 0.11, 2.16, p=0.029) and highly active (&#946;1.62; 95%CI = 0.58, 2.67; p=0.002) participants had higher QOL during AS. Highly active participants were more likely to experience high emotional well-being (OR =1.55 95%CI = 1.11, 2.16; p= 0.010) over time compared to their inactive counterparts. In a subgroup analysis for men with low emotional well-being early on during AS, engaging in > 1000 MET-min/wk (highly active) was associated with greater odds of experiencing high emotional well-being over time (OR = 2.17; 95%CI = 1.06, 4.46, p= 0.034) relative to lowest PA (<210 MET-min/wk). CONCLUSIONS: Our findings emphasize the importance of PA as a supportive care strategy during AS for low-risk prostate cancer.

CN2 - PREDICTING UTILITY SCORES IN LOCALIZED PROSTATE CANCER: MAPPING FROM EPIC TO PORPUS

The Patient-Oriented Prostate Utility Scale (PORPUS-U) is the only econometric instrument specifically designed for prostate cancer patients. The Expanded Prostate cancer Index Composite (EPIC) and the SF-36 are the most used instruments in these patients. This study aims to estimate the PORPUS-U index by EPIC and SF-36 scores to allow cost-utility analysis. The Spanish Multicentric Localized Prostate Cancer Study in new therapeutic modalities included patients diagnosed between 2014 and 2017 (n=469). PORPUS-U, EPIC and SF-36 were administered by telephone. The predictive model was constructed with the evaluation 3 months after treatment, and validated with evaluations at 6, 12, 24 and 36 months. A linear regression model was constructed with the logarithmic transformation of the PORPUS-U index as the dependent variable, and EPIC scores and the SF-36 physical and mental summary components as explanatory variables. All possible first level interactions were tested. R2 and Root Mean Square Error (RMSE) of the model were considered. Agreement between the estimated index and the observed one was calculated with the Intraclass Correlation Coefficient (ICC). The model chosen included six EPIC scores (urinary incontinence and irritative-obstructive, sexual function and bother, bowel and hormonal) and the two summary components of the SF-36: R2=0.793, RMSE=0.036 and ICC=0.914. The validation models showed RMSE ranging 0.031-0.045 and ICC ranging 0.838-0.922. The means (SD) of the PORPUS-U index observed and predicted by the model were: 0.97 (0.04) vs. 0.96 (0.05) at 6 months, 0.97 (0.05) vs. 0.96 (0.06) at 12 months, 0.96 (0.05) vs. 0.96 (0.07) at 24 months and 0.97 (0.06) vs. 0.95 (0.06) at 36 months. The model constructed with EPIC scores and the two SF-36 summary components presented a good predictive capacity to estimate the PORPUS-U utility index, which could be useful to allow cost-utility analysis in studies without an econometric instrument.

Health state utilities among contemporary prostate cancer patients on active surveillance.

BackgroundActive surveillance (AS) is the most rapidly expanding management option for favorable-risk prostate cancer (PCa). Early studies suggested substantial decrements in utility (quality of life weights) from disease-related anxiety. Our objective was to determine utilities for contemporary AS patients using different instruments.MethodsWe performed a systematic review of PubMed, PMC and OVID for utility measurements in modern AS patients. We then examined utilities among 37 men on AS participating in focus groups between 2015–2016 using the generic EurQol five dimensions questionnaire (EQ-5D-3L) and Patient Oriented Prostate Utility Scale (PORPUS), a PCa-specific instrument.ResultsThe systematic review found previous studies with utilities for PCa treatment and historical watchful waiting populations, but none specifically in contemporary AS. In our AS population, the mean EQ-5D-3L score was 0.90±0.16 (median, 1.00; range, 0.21–1.00) and PORPUS was 0.98±0.03 (median, 0.99; range, 0.84–1.00). The Spearman correlation between the EQ-5D-3L and PORPUS was 0.87 (P<0.0001), and 38% of patients had a difference >0.1 between instruments.ConclusionsMost contemporary AS patients had high utility scores suggesting that they perceive themselves in good health without a major decrement in quality of life from the disease. However, some patients had substantial differences in utility measured with generic versus disease-specific instruments. Further study is warranted into the optimal instrument for utility assessment in contemporary AS patients.

Health-related quality of life in robotic versus open radical prostatectomy.

It is unclear whether health-related quality of life (HRQoL) outcomes are superior in robot-assisted radical prostatectomy (RARP) compared to open prostatectomy (ORP). We retrospectively analyzed records from men who received ORP or RARP at our institution between January 2009 and December 2012. Patients completed a demographics questionnaire and the Patient-Oriented Prostate Utility Scale (PORPUS), a validated disease-specific HRQoL instrument prior to surgery and every 3 months up to 15 months after surgery. In total, 974 men met the inclusion criteria (643 ORP and 331 RARP patients). At baseline, RARP patients were significantly younger (p < 0.001), had lower body mass index (BMI) (p < 0.001), lower preoperative prostate-specific antigen (PSA) (p < 0.001), fewer comorbidities (p < 0.004), and higher baseline PORPUS scores (p = 0.024). On follow-up, unadjusted PORPUS scores were significantly higher in the RARP group at each point. On multivariable analysis adjusting for age, ORP versus RARP procedure, Gleason score, BMI, first PSA, comorbidity, ethnicity, and baseline PORPUS scores, PORPUS score was higher for the RARP group at 3 months (p = 0.038) and 9 months (p = 0.037), but not at 6, 12, and 15 months (p = 0.014). No difference met pre-defined thresholds of clinical significant. Though unadjusted HRQoL outcomes appeared improved with RARP compared to ORP differences, adjusted differences were seen at only 2 of 5 postoperative time points, and did not meet pre-defined thresholds of clinical significance. Further randomized trials are needed to assess whether one treatment option provides consistently better HRQoL outcomes.

Adaptation and validation of the Spanish version of the Patient-Oriented Prostate Utility Scale (PORPUS).

The Patient-Oriented Prostate Utility Scale (PORPUS) is a combined profile and utility-based quality of life measure for prostate cancer patients. Our objectives were to adapt the PORPUS into Spanish and to assess its acceptability, reliability, and validity. The PORPUS was adapted into Spanish using forward and back translations and cognitive debriefing. PORPUS was administered jointly with the SF-36 and the Expanded Prostate Index Composite (EPIC) to 480 Spanish prostate cancer patients treated with radical prostatectomy or radiotherapy. The Spanish PORPUS scores' distribution and reliability were examined and compared with the original instrument. To evaluate construct validity, relationships were assessed between PORPUS and other instruments (testing hypotheses of the original PORPUS study), and among known groups defined by side effect severity. Reliability coefficient was 0.76 (similar to the original PORPUS' 0.81). Spanish PORPUS items presented correlations ranging 0.57-0.88 with the corresponding EPIC domains, as in the original PORPUS study (0.60-0.83). Both PORPUS-P and PORPUS-U showed significant differences and large effect sizes (0.94-1.90) when comparing severe versus no problem groups on urinary, bowel, sexual and hormonal side effects defined by EPIC. A conceptually equivalent Spanish version was obtained, with high reliability and good construct validity, similar to the original Canadian PORPUS version. It can therefore be used to measure health-related quality of life and utilities in Spanish prostate cancer patients.

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

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 ...

MP15-06 HEALTH-RELATED QUALITY OF LIFE IN ROBOTIC VERSUS OPEN RADICAL PROSTATECTOMY: FIRST REPORT

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2014MP15-06 HEALTH-RELATED QUALITY OF LIFE IN ROBOTIC VERSUS OPEN RADICAL PROSTATECTOMY: FIRST REPORT Stacy Rush, Shabbir M.H. Alibhai, Lizhen Xu, Wei Xu, Alyssa S. Louis, Andrew G. Matthew, Michael Nesbitt, Antonio Finelli, Neil E. Fleshner, Robert Hamilton, Girish Kulkarni, Alexandre Zlotta, Michael AS. Jewett, and John Trachtenberg Stacy RushStacy Rush More articles by this author , Shabbir M.H. AlibhaiShabbir M.H. Alibhai More articles by this author , Lizhen XuLizhen Xu More articles by this author , Wei XuWei Xu More articles by this author , Alyssa S. LouisAlyssa S. Louis More articles by this author , Andrew G. MatthewAndrew G. Matthew More articles by this author , Michael NesbittMichael Nesbitt More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Neil E. FleshnerNeil E. Fleshner More articles by this author , Robert HamiltonRobert Hamilton More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , Alexandre ZlottaAlexandre Zlotta More articles by this author , Michael AS. JewettMichael AS. Jewett More articles by this author , and John TrachtenbergJohn Trachtenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.559AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite growing use of robot-assisted laparoscopic radical prostatectomy (RARP), it is unclear if health-related quality of life (HRQoL) outcomes are superior to open prostatectomy (ORP). METHODS We retrospectively analyzed records from men who received ORP or RARP at our institution as their primary therapy for prostate cancer between January 2009 and December 2012. Patients completed a demographics questionnaire and the Patient-Oriented Prostate Utility Scale (PORPUS), a validated disease-specific HRQoL instrument prior to surgery and every 3 months up to 15 months after surgery. RESULTS A total of 974 men met the inclusion criteria, 643 ORP and 331 RARP patients. At baseline, RARP patients were significantly younger (p<0.001), had lower body mass index (p<0.001), lower pre-operative prostate-specific antigen (PSA) (p<0.001), fewer comorbidities (p<0.004) and higher baseline PORPUS scores (p=0.024). On follow-up, unadjusted PORPUS scores were significantly higher in the RARP group at each point. However, on multivariable analysis adjusting for age, type of procedure (ORP vs. RARP), Gleason score, BMI, first PSA, comorbidity, ethnicity, and baseline PORPUS scores, PORPUS score was higher for the RARP group at 3 months (p=0.031) and 9 months (p=0.002), but not at 6, 12 or 15 months. No difference was greater than the minimum clinically significant difference. CONCLUSIONS Though HRQoL outcomes appear improved with RARP, these differences are not clinically important and are likely accounted for by baseline differences in patient selection. Further comparative studies and randomized trials are needed to assess whether one treatment option provides consistently better HRQOL outcomes. Table 1. Baseline demographics of study patients Factors Open Robotic p-value Age (Years) N 643 331 Mean (sd) 61.49(7.07) 59.71(7.03) <0.001 First Elevated PSA N 432 195 Mean (sd) 7.58 (5.22) 5.89 (3.28) <0.001 BMI N 597 299 Mean (sd) 28.6 (4.0) 27.3 (3.6) <0.001 Charlson comorbidity score 0 512 (80) 289 (87) > = 1 131 (20) 42 (13) 0.004 Biopsy Gleason Score N (%) Low/Intermediate risk: Gleason 4, 5, 6, or 7 532 (88) 310 (99) High risk: Gleason 8, 9, 10 76 (12) 4 (1) <0.001 Ethnicity Caucasian: n(%) 228 (75) 98 (63) Non Caucasian n(%) 75 (25) 58 (37) 0.008 PORPUS-P Score N 437 210 Mean (sd) 82.59(11.10) 84.73(11.26) 0.024 Nerve Sparing Status None: n (%) 155 (25) 19 (7) Unilateral: n (%) 146 (23) 45 (15) Bilateral: n (%) 326 (52) 224 (78) <0.001 Data are shown only for statistically significantly different characteristics. Table 2. Univariate predictors of baseline (pre-operative) PORPUS-P Variable Effect Confidence Interval p-value Age -0.22 (-0.34,-0.105) <0.001 Type of RP∗ 2.14 (0.30,3.98) 0.023 Gleason Score -4.35 (-7.33,-1.37) 0.004 BMI -0.025 (-0.26,0.21) 0.836 First Positive PSA -0.24 (-0.44, -0.04) 0.017 ∗ RARP compared to ORP © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e146-e147 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Stacy Rush More articles by this author Shabbir M.H. Alibhai More articles by this author Lizhen Xu More articles by this author Wei Xu More articles by this author Alyssa S. Louis More articles by this author Andrew G. Matthew More articles by this author Michael Nesbitt More articles by this author Antonio Finelli More articles by this author Neil E. Fleshner More articles by this author Robert Hamilton More articles by this author Girish Kulkarni More articles by this author Alexandre Zlotta More articles by this author Michael AS. Jewett More articles by this author John Trachtenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Erratum: Predicting utility scores for prostate cancer: mapping the Prostate Cancer Index to the Patient-Oriented Prostate Utility Scale (PORPUS)

Erratum: Predicting utility scores for prostate cancer: mapping the Prostate Cancer Index to the Patient-Oriented Prostate Utility Scale (PORPUS)

The effect of meeting physical activity guidelines for cancer survivors on quality of life following radical prostatectomy for prostate cancer

Recent literature has shown that preoperative physical activity (PA) can positively influence surgical outcomes. It is unknown whether the effect of meeting PA guidelines for cancer survivors can impact quality of life following radical prostatectomy for prostate cancer. We reviewed our institutional database of prostate cancer outcomes and included patients that underwent radical prostatectomy and completed the Godin-Shephard Leisure Time Exercise Questionnaire (GLTEQ), the Patient-Oriented Prostate Utility Scale (PORPUS), the International Prostate Symptom Score (IPSS), and the five-item International Index of Erectile Function (IIEF). Participants were categorized as meeting or not meeting the American College of Sports Medicine physical activity guidelines for cancer survivors (150 min of moderate intensity or 75 min of vigorous intensity PA per week). Radical prostatectomy outcomes were measured preoperatively and at 6 and 26-weeks postoperatively. From June 2008 to August 2012, 509 men underwent curative, nerve-sparing radical prostatectomy for prostate cancer and completed the GLTEQ, of whom 46% met the PA guidelines. Prior to surgery, men that met the PA guidelines reported higher quality of life (p < 0.001) and erectile function (p = 0.049) than men that did not meet the guidelines. Quality of life at all postoperative timepoints was higher for men that met the PA guidelines after adjusting for age, preoperative body mass index, and surgical approach (p = 0.02). Men that met the PA guidelines were 19% less likely to be incontinent at 6 weeks postoperatively (p = 0.028). PA volume may be a useful marker at predicting postoperative recovery of quality of life and urinary incontinence following radical prostatectomy. Cancer survivors should be encouraged to meet PA guidelines prior to surgery in an effort to attenuate the decline in HRQOL and facilitate recovery.

Predicting utility scores for prostate cancer: mapping the Prostate Cancer Index to the Patient-Oriented Prostate Utility Scale (PORPUS)

The Prostate Cancer Index (PCI) is a health profile instrument that measures health-related quality of life with six subscales: urinary, sexual, and bowel function and bother. The Patient-Oriented Prostate Utility Scale (PORPUS-U) measures utility (0=dead and 1=full health). Utility is a preference-based approach to measure health-related quality of life, required for decision analyses and cost-effectiveness analyses. We developed a function to estimate PORPUS-U utilities from PCI scores. The development data set included 676 community-dwelling prostate cancer (PC) survivors who completed the PCI and PORPUS-U by mail. We fit three linear regression models: one used original PORPUS-U scores and two used log-transformed PORPUS-U scores, one with a hierarchy constraint and one without. The model selection was performed using stepwise selection and fivefold cross validation. The validation data included 248 PC outpatients with three assessments on the PCI and PORPUS-U. Scores were retransformed for validation, with Duan's smearing estimator applied to correct potential bias. The predictive ability of the models was assessed with R(2), root mean square error (RMSE) and by comparing predicted and observed utilities. The best-fitting model used the log-transformed PORPUS-U with no hierarchy constraint. The R(2) was 0.72. The RMSE ranged from 0.040 to 0.061 for the three validation data sets. Differences between predicted and observed utilities ranged from 0.000 to 0.006 but predicted utilities overestimated the lowest 5% of observed PORPUS-U scores and underestimated the highest observed scores. Our algorithm can calculate PORPUS-U utility scores from PCI scores, thus supplementing descriptive quality of life measures with utility scores in PC patients. Utilities derived from mapping algorithms are useful for assigning utility to groups of patients but are less accurate at predicting utility of individual patients. We are exploring statistical methods to improve the mapping of utilities from descriptive instruments.

The effect of nerve-sparing surgery on patient-reported continence post-radical prostatectomy

Urinary continence significantly affects quality of life after radical prostatectomy (RP). The impact of nerve-sparing surgery on continence is unclear from the current literature. We identified men with prostate cancer from the University Health Network Prostate Centre database who underwent RP. Preoperatively and at each postoperative visit, patients completed the Patient-Oriented Prostate Utility Scale (PORPUS), a validated psychometric and health utility instrument. Incontinence was defined by a single questionnaire item. Patients with radiotherapy or less than 10 months follow-up were excluded. Chi-squared tests and ANOVA were used to compare groups. Multivariable logistic regression was used to control for effects of nerve-sparing and other covariates. Of the 253 eligible patients from 2003 to 2007, 159 patients had bilateral nerve-sparing, 32 had unilateral nerve-sparing and 62 had non-nerve-sparing surgery. Of these patients, 27%, 17% and 34%, respectively, were classified as incontinent at 1 year. These proportions were not significantly different between groups (p = 0.23). Multivariable logistic regression showed baseline urinary continence and urinary frequency to be significant predictors of patient-reported continence at 1 year postoperatively, with odds ratios of 1.7 (95% confidence interval [CI] 1.1-2.9) and 1.5 (95% CI 1.0-2.3), respectively. There was a significant difference in the proportion of PORPUS sexual function scores between nerve-sparing groups after excluding those with baseline sexual dysfunction (p = 0.003). Similarly, health-related utility scores were different across groups (p < 0.001). Our results do not suggest a difference in 1-year patient-reported continence based on the type of nerve-sparing RP. However, baseline continence and urinary frequency were significant predictors of continence at 1 year.

Changes in health utilities and health-related quality of life over 12 months following radical prostatectomy

Although radical prostatectomy (RP) is an effective treatment for prostate cancer, it has potentially deleterious effects on health-related quality of life (HRQoL). Utility is an important global measure of HRQoL. This utility is also used in decision-making models and economic evaluations. There are no published prospective data characterizing men's utilities for health outcomes post-RP. From July 2003 to June 2006, patients undergoing RP at the University Health Network in Toronto, Ontario, Canada, completed the Patient-Oriented Prostate Utility Scale (PORPUS), a disease-specific HRQoL and utility instrument. Men were included if they had clinically localized prostate cancer and had completed HRQoL measures prior to surgery and at least once within 9 to 18 months after the RP. Health-related quality of life was measured prior to surgery and at 4 stages after surgery: 0 to 3 months, 3 to 9 months, 9 to 18 months, and 18 to 30 months. Statistical analyses included pairwise t-tests and multivariable linear regression comparing changes in scores between baseline and the 9- to 18-month range. Two hundred and thirteen men (mean age 60.9, median Gleason score 7) met the inclusion criteria. At baseline, HRQoL was high (mean PORPUS-P [psychometric] = 83.8). Scores declined sharply by 3 months (65.5, p < 0.001) and improved but did not reach baseline by 9-18 months (75.1, p < 0.001). Utility scores (PORPUS-U[utility]) showed the same pattern: 0.94 at baseline; 0.81 at 3 months (p < 0.001); and 0.88 at 9 to 18 months (p < 0.001). Predictors of HRQoL, including baseline PORPUS score, nerve-sparing surgery and smoking status, decline after RP. Symptom scores are known to be affected up to 12 months after RP. Our study demonstrates that global health status also declines and remains affected 1 year after surgery.

A reference set of health utilities for long-term survivors of prostate cancer: population-based data from Ontario, Canada

To measure quality of life (QOL) and utilities for prostate cancer (PC) patients and determine their predictors. A population-based, community-dwelling, geographically diverse sample of long-term PC survivors in Ontario, Canada, was identified from the Ontario Cancer Registry and contacted through their referring physician. Consenting patients completed questionnaires by mail: Health Utilities Index (HUI 2/3), Patient Oriented Prostate Utility Scale PORPUS-U (utility), PORPUS-P (health profile), Functional Assessment of Cancer Therapy-Prostate (FACT-P), and Prostate Cancer Index (PCI). Clinical data were obtained from chart reviews. Regression models determined the effects of a series of variables on QOL and utility. We received questionnaires and reviewed charts for 585 patients (mean age 72.6, 2-13years postdiagnosis). Mean utility scores were as follows: PORPUS-U=0.92, HUI2=0.85, and HUI3=0.78. Mean health profile scores were as follows: PORPUS-P=71.7, PCI sexual, urinary, and bowel function=23.7, 79.1, and 84.6, respectively (0=worst, 100=best), and FACT-P=125.1 (0=worst, 156=best). In multiple regression analyses, comorbidity and PCI urinary, sexual, and bowel function were significant predictors of other QOL measures. With all variables, 32-50% of the variance in utilities was explained. Many variables affect global QOL of PC survivors; only prostate symptoms and comorbidity have independent effects. Our model allows estimation of the effects of multiple factors on utilities. These utilities for long-term outcomes of PC and its treatment are valuable for decision/cost-effectiveness models of PC treatment.

Development and Validation of a Utility Weighting Function for the Patient-Oriented Prostate Utility Scale (PORPUS)

Previously, we developed a prostate cancer (PC)-specific health state classification system, the Patient Oriented Prostate Utility Scale (PORPUS). In this study, we developed a scoring system to allow indirect calculation of utilities from the PORPUS. We interviewed 234 PC outpatients, including those with newly diagnosed and metastatic disease, to obtain rating scale (RS) values on 4 to 6 levels of each of the 10 attributes of the PORPUS, and on 10 corner states (worst level on 1 attribute, best on 9). Patients also completed standard gamble (SG) and RS tasks on 4 multiattribute states (impotence and pain corner states, mild and severe PC symptoms). We used the RS and SG scores for multiattribute states to determine a risk aversion function for mapping values to utilities. We then tested 15 different strategies to estimate the multiattribute utility function (MAUF), using the single attribute disutilities for each level of the 10 PORPUS attributes, and the disutilities for the corner states. The root mean squared error (RMSE) of prediction of the SG on the 4 multiattribute states was used to identify the optimal strategy and scoring system. The optimal strategy gave an RMSE of 0.06. Comparison of mean MAUF-predicted utilities to directly elicited SG utilities for the 2 multiattribute states from patients in 2 previously published studies (n = 248 and n = 141) supported the validity of the MAUF. The scoring system together with the PORPUS comprise an indirect utility instrument, the PORPUS-U, which can be used in clinical and research settings.

Impact of Androgen Deprivation Therapy on Physical and Cognitive Function, as Well as Quality of Life of Patients With Nonmetastatic Prostate Cancer

Many patients with prostate cancer receive androgen deprivation therapy for long periods. We compared physical and cognitive function, and quality of life in a cross-sectional study of 57 patients receiving androgen deprivation therapy for nonmetastatic prostate cancer and 51 healthy age matched controls. Physical and daily function were measured by the 6-minute walk test, grip strength, the timed up and go test, and activities of daily living measures. Cognitive function was evaluated by the High Sensitivity Cognitive Screen and by a self-report prototype Functional Assessment of Cancer Therapy cognitive function subscale. Quality of life was assessed by the Functional Assessment of Cancer Therapy-General with the subscale for fatigue and by the Patient-Oriented Prostate Utility Scale. Androgen deprivation therapy was given for a median of 1.8 years (range 0.4 to 7.4). Patients had lower median hemoglobin than controls (134 vs 148 gm/l, p <0.0001). Performance on physical tests was similar in the 2 groups. Moderate or severe cognitive impairment by the High Sensitivity Cognitive Screen was similar for patients (23%) and controls (35%, p = 0.2). Self-reported cognitive dysfunction was also similar. Scores for the Functional Assessment of Cancer Therapy-General were similar but the Patient Oriented Prostate Utility Scale summary score was worse for patients (median 71 vs 86, p <0.001). More patients reported severe fatigue (Functional Assessment of Cancer Therapy-Fatigue score less than 35, p = 0.03). Low energy, poor bladder control and loss of sexual function were reported in 36%, 47% and 95% of patients, and in 16%, 34% and 33% of controls, respectively. Patients treated with androgen deprivation therapy experience more symptoms and have worse fatigue than controls, but this study did not detect any effect on physical or cognitive function.

Preferences for short versus long - term androgen deprivation in prostate cancer survivors

4620 Background: RTOG 92–02 has demonstrated that long-term androgen deprivation prolongs cause –specific survival in patients with locally advanced prostate cancer by 3.4 %. However, androgen deprivation decreases sexual function, reduces bone mass, and health - related quality of life. Methods: Patients with prostate cancer who received radiotherapy were presented with a scenario of Locally Advanced Prostate Cancer. We determined the minimally required increment in survival (MRIS) to accept LTAD (as opposed to STAD), using the Probability trade –off (PTO) technique. Utilities for impotence and osteoporosis associated with LTAD were determined using the Time trade –off (TTO) technique. The participants' current erectile function and prostate cancer –specific health –related quality of life were assessed using the International Index of Erectile Function (IIEF), and the Patient –Oriented Prostate Utility scale (PORPUS), respectively. Results: Sixty-seven patients were interviewed. The median age of partic...

Construction of the Patient-Oriented Prostate Utility Scale (PORPUS): a multiattribute health state classification system for prostate cancer

Health status indexes, such as the EuroQol, consist of a health state classification system and a set of utility weights. Indexes measure quality of life using a 0–1 utility score. Utilities for outcomes in prostate cancer (PC) are of unique importance, but generic indexes do not represent PC outcomes (e.g., sexual, urinary, bowel dysfunction) well, and may not capture their full impact. As a step toward improved utility measurement, we constructed a classification system for PC. We generated items for each of six health domains and rated their importance using interviews with 10 clinical experts and 80 patients. Key concepts were selected for each domain using item importance weightings, and a set of predetermined criteria. Text was developed to express levels of severity within each domain. Experts and two additional groups of patients ( n = 40, n = 96) evaluated textual clarity and endorsed the content validity of the instrument. The final system consists of 10 domains with 4–6 levels each. The content validity of the system was endorsed by patients and experts. In conjunction with a set of utility weights, it may be used to develop a health status index, to improve utility measurement in patients, and to serve as a short psychometric (nonutility) instrument.