Prostate Cancer-specific Quality Of Life Research Articles

Evaluation of Perioperative Clinical Parameters and Quality of Life in Patients Undergoing Radical Perineal or Retropubic Prostatectomy: A Prospective Randomized Study

Objective: The objective of study is to investigate the effects of radical retropubic and perineal prostatectomy methods in addition to the effect of pelvic lymph node dissection on perioperative morbidities, oncological outcomes and 1-year quality of life in patients with clinically local stage prostate cancer. Material and methods: Patients admitted to our clinic between January 2013 and March 2015 and diagnosed with clinically localized stage prostate cancer were included. A total of 103 patients were randomized into 3 groups in which 38 patients received radical perineal prostatectomy(RPP), 31 had radical retropubic prostatectomy(RRP), and 34 RRP with pelvic lymph node dissection(PLND). Age, comorbidities, preoperative Gleason scores and serum prostate-specific antigen(PSA) data as well as the surgical parameters, clinical and pathological stages, and 1-year follow-up data were recorded for each patient.“Extended prostate cancer index composite (EPIC)” and “SF-12v2™ Health Survey(Version 2.0)” questionnaires were used for overall and disease-specific quality of life at month 0, 1, 6 and 12 visits. Results: No difference was found between the groups with regard to preoperative data such as age, serum PSA levels, clinical stage, biopsy Gleason score and Charlson comorbidity index while intraoperative data for the amount of bleeding and the average amount of transfusion were significantly lower in RPP group(RPP:645cc, RRP:960cc, RRP+PLND:890cc).1-year recurrencefree survivals for RPP, RRP, and RRP+PLND groups were 9.9 months, 11.2 months and 10.2 months, respectively, with no significant difference.Overall and prostate cancer-specific quality of life was similar for all 3 groups.No additional benefit with nerve-sparing surgery was shown in any of the groups in terms of incontinence and erectile functions. Conclusion: Perineal dissection is beneficial in terms of the amount of bleeding and blood transfusion while prolonged postoperative drainage and wound infection rates are higher compared to retropubic approach.All 3 groups were similar in urinary, sexual, gastrointestinal and hormonal functions as well as the quality of life.

Impact of Comprehensive Health Insurance on Quality of Life in Low-Income Hispanic Men with Prostate Cancer

ObjectiveTo evaluate the effect of the transition from IMPACT, a disease-focused treatment program, to comprehensive health insurance under Medicaid through the Affordable Care Act (ACA) on general and prostate cancer-specific quality of life (QoL) on a cohort of previously uninsured low-income men. We hypothesize that general QoL would improve and prostate cancer-specific QoL would remain the same after the transition to comprehensive health insurance. MethodsWe assessed and compared general QoL using the RAND SF-12v2™ (12-Item Short Form Survey, version 2) and prostate cancer-specific QoL using the UCLA PCI (Prostate Cancer Index) one year before, at, and one year after the transition between 30 men who transitioned to comprehensive insurance (newly insured/Medicaid group) and 54 men who remained in the prostate cancer program (uninsured/IMPACT group). We assessed the independent effects of Medicaid coverage on QoL outcomes using repeated-measures regression. ResultsOur cohort was composed primarily of Hispanic men (82%). At transition, patient demographics and clinical characteristics were similar between the groups. General and prostate cancer-specific QoL did not differ between the groups and remained stable over time, Radical prostatectomy as primary treatment and shorter time since treatment were associated with worse urinary and sexual function across both groups and over all three time points. ConclusionThose who transitioned to full-scope insurance and those who remained in the free prostate cancer-focused treatment program had stable general and prostate cancer-specific QoL. High-touch navigation aspects of a disease-focused program may have contributed to stability in outcomes.

MP13-18 IMPACT OF COMPREHENSIVE HEALTH INSURANCE COVERAGE ON QUALITY OF LIFE IN LOW-INCOME MEN WITH PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP13-18 IMPACT OF COMPREHENSIVE HEALTH INSURANCE COVERAGE ON QUALITY OF LIFE IN LOW-INCOME MEN WITH PROSTATE CANCER Allen E.D. Siapno, Thomas W. Gaither, Megha D. Tandel, Lorna Kwan, Ying-Ying Meng, Sally Maliski, Arlene Fink, and Mark S. Litwin Allen E.D. SiapnoAllen E.D. Siapno More articles by this author , Thomas W. GaitherThomas W. Gaither More articles by this author , Megha D. TandelMegha D. Tandel More articles by this author , Lorna KwanLorna Kwan More articles by this author , Ying-Ying MengYing-Ying Meng More articles by this author , Sally MaliskiSally Maliski More articles by this author , Arlene FinkArlene Fink More articles by this author , and Mark S. LitwinMark S. Litwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002542.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Affordable Care Act (ACA) expanded Medicaid coverage to a portion of previously uninsured low-income men receiving free disease-focused navigation-based care through the Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT) program. To determine the effect of the transition to comprehensive health insurance on health-related quality of life (QoL), we compared men who transitioned to full-scope insurance through the ACA to men who were ACA-ineligible and continued care in IMPACT. METHODS: We retrospectively reviewed survey data on IMPACT enrollees when the ACA went into effect in 2014, creating a natural experimental cohort with some men transitioning from IMPACT to ACA coverage (intervention group) and other men remaining in IMPACT (control group). Subjects completed three surveys: one year before, at, and one year after the transition. The main outcomes were two composite domains of general QoL in the RAND 12-Item Health Survey (SF-12) and six domains of prostate cancer-specific QoL in the UCLA Prostate Cancer Index. Statistical analysis compared demographics, clinical characteristics, and the QoL measures. We assessed the independent effects of ACA coverage on QoL outcomes using repeated-measures regression. RESULTS: 84 men (30 intervention, 54 control) met inclusion criteria. Mean age was 61.3 years (SD 7.4), 82% were Hispanic, and 64% were living with their spouse/partner. At the transition, the intervention group was enrolled in IMPACT for less time (40% vs 70% enrolled >1 year, p=0.02) and were less likely to be actively smoking (30% vs 54%, p=0.04). QoL scores at the transition were similar for both groups except for better sexual function in the intervention group (40.0 vs 23.7, p=0.01). QoL did not differ over time between the groups, but sexual function in both groups declined from pre- to post-transition (Table 1). CONCLUSIONS: Both of those who transitioned to full-scope insurance or remained in a free prostate cancer treatment program had stable general and prostate cancer-specific QoL. Decline in sexual function may be time- or age-related. High-touch navigation aspects of a disease-focused program may have contributed to stability in outcomes. Source of Funding: IMPACT receives funding from the California Department of Health Care Services. Research was funded by the American Cancer Society Research Grant © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e229 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Allen E.D. Siapno More articles by this author Thomas W. Gaither More articles by this author Megha D. Tandel More articles by this author Lorna Kwan More articles by this author Ying-Ying Meng More articles by this author Sally Maliski More articles by this author Arlene Fink More articles by this author Mark S. Litwin More articles by this author Expand All Advertisement PDF DownloadLoading ...

Quality of life after robotic-assisted and laparoscopic radical prostatectomy: Results of a multicenter randomized controlled trial (LAP-01).

To explore cross-sectional and longitudinal differences in general health-related and prostate cancer-specific quality of life (QoL) after robotic-assisted (RARP) and laparoscopic (LRP) radical prostatectomy and to analyze predictive variables for QoL outcomes. In this multicenter, randomized controlled trial, prostate cancer patients were randomly assigned 3:1 to undergo either RARP or LRP. Patient-reported outcomes were prospectively collected before and 1, 3, 6, 12 months after radical prostatectomy and included QoL as a secondary outcome. Validated questionnaires were used to assess general health-related (EORTC QLQ-C30) and prostate cancer-specific (QLQ-PR25) QoL. Cross-sectional and longitudinal contrasts were analyzed through linear mixed models. Predictive variables for QoL outcomes were identified by general linear modeling. Of 782 randomized patients, QoL was evaluable in 681 patients. In terms of general QoL, the cross-sectional analysis showed only small differences between study arms, whereas longitudinal comparison indicated an advantage of RARP on recovery: RARP patients reported an earlier return to baseline in global health status (3 vs. 6 months) and social functioning (6 vs. 12 months). In role functioning, only the RARP arm regained baseline scores. Regarding prostate-specific QoL, LRP patients experienced more urinary symptoms and reported 3.2 points (95% confidence interval 0.4-6, p = 0.024) higher mean scores at 1-month follow-up and in mean 2.9 points (0.1-5, p = 0.042) higher urinary symptoms scores at 3-month follow-up than RARP patients. There were no other significant differences between treatment groups. Urinary symptoms, sexual activity, and sexual function remained significantly worse compared with baseline at all time points in both arms. Compared with LRP, the robotic approach led to an earlier return to baseline in several domains of general health-related QoL and better short-term recovery of urinary symptoms. Predictive variables such as the scale-specific baseline status and bilateral nerve-sparing were confirmed.

Navigate: a study protocol for a randomised controlled trial of an online treatment decision aid for men with low-risk prostate cancer and their partners

BackgroundActive surveillance (AS) is the disease management option of choice for low-risk prostate cancer. Despite this, men with low-risk prostate cancer (LRPC) find management decisions distressing and confusing. We developed Navigate, an online decision aid to help men and their partners make management decisions consistent with their values. The aims are to evaluate the impact of Navigate on uptake of AS; decision-making preparedness; decisional conflict, regret and satisfaction; quality of illness communication; and prostate cancer-specific quality of life and anxiety. In addition, the healthcare cost impact, cost-effectiveness and patterns of use of Navigate will be assessed. This paper describes the study protocol.MethodsThree hundred four men and their partners are randomly assigned one-to-one to Navigate or to the control arm. Randomisation is electronically generated and stratified by site. Navigate is an online decision aid that presents up-to-date, unbiased information on LRPC tailored to Australian men and their partners including each management option and potential side-effects, and an interactive values clarification exercise. Participants in the control arm will be directed to the website of Australia’s peak national body for prostate cancer. Eligible patients will be men within 3 months of being diagnosed with LRPC, aged 18 years or older, and who are yet to make a treatment decision, who are deemed eligible for AS by their treating clinician and who have Internet access and sufficient English to participate. The primary outcome is self-reported uptake of AS as the first-line management option. Secondary outcomes include self-reported preparedness for decision-making; decisional conflict, regret and satisfaction; quality of illness communication; and prostate cancer-specific quality of life. Uptake of AS 1 month after consent will be determined through patient self-report. Men and their partners will complete study outcome measures before randomisation and 1, 3 and 6 months after study consent.DiscussionThe Navigate online decision aid has the potential to increase the choice of AS in LRPC, avoiding or delaying unnecessary radical treatments and associated side effects. In addition, Navigate is likely to reduce patients’ and partners’ confusion and distress in management decision-making and increase their quality of life.Trial registrationAustralian and New Zealand Clinical Trial Registry ACTRN12616001665426. Registered on 2 December 2016. All items from the WHO Trial Registration Data set can be found in this manuscript.

Football Compared with Usual Care in Men with Prostate Cancer (FC Prostate Community Trial): A Pragmatic Multicentre Randomized Controlled Trial

BackgroundPhysical activity has been shown to mitigate the unwanted psychological and physiological side effects of prostate cancer treatments, but sustainable exercise possibilities are limited.ObjectiveOur objective was to examine whether football in a real-world setting (i.e., local football clubs) was safe and feasible in practice and could improve quality of life, mitigate decline in muscle mass and bone density, and increase fat mass in patients with prostate cancer.MethodsIn this pragmatic, multicentre, parallel randomized controlled trial, men diagnosed with prostate cancer were recruited from five Danish urological departments. Men (N = 214) diagnosed with prostate cancer were randomly allocated, using random generated lists (block size 4–8) stratified for center and androgen-deprivation therapy status, to either 1 h of football twice weekly in a local football club or to usual care, which was a 15- to 30-min telephone session covering their options for physical activity or free-of-charge rehabilitation delivered as standard in Denmark. Allocation was concealed from the trial investigator performing the randomization, but—given the nature of the intervention—this was not possible for personnel and participants. Assessments were performed at baseline, 12 weeks, and 6 months. The primary outcome was mean change difference in prostate cancer-specific quality of life at 12 weeks. Secondary outcomes were body composition, 12-Item Short Form Health Survey (SF-12) physical and mental health, and safety—reported as fractures, falls, and serious adverse events.ResultsAttrition was 1 and 3% at 12 weeks, and 5% and 5% at 6 months for the usual care and football groups, respectively. Prostate cancer-specific quality of life was equal between groups at 12 weeks (mean difference + 1.9 points, 95% confidence interval [CI] –1.0–4.8; P = 0.20) and at 6 months (+ 0.5 points, 95% CI –2.8–3.8; P = 0.76). Fractures were equally distributed, with two fractures in the usual care group and one in the football group. Likewise, body composition outcomes were equal. Mental health improved after 6 months of football (mean difference + 2.7 points, 95% CI 0.8–4.6; P = 0.006).ConclusionsIn this trial, community-based football was a feasible exercise strategy for men with prostate cancer. Football did not improve prostate cancer-specific quality of life but did improve mental health; the clinical significance of this is unclear.Trial registrationClinicalTrials.gov: NCT02430792.

Enhancing Quality of Life Through an Innovative, Multidisciplinary Model of Supportive Cancer Care and Rehabilitation

Background: Advancements in diagnosis and cancer treatment mean survival rates have improved but as a consequence many people are living with the adverse physical effects of complex treatments, financial hardship, work and relationship stress, and fear of recurrence. Person-centered, holistic care is required to help people maximize all aspects of their quality of life when living with and beyond their cancer, but debate continues around which models are economically sustainable and effective in achieving the desired outcomes. Maggie's ( www.maggiescentres.org ) is an innovative, multidisciplinary model of holistic supportive cancer care, widely regarded as an exemplar of best practice in cancer rehabilitation and supported self-management. In 2017 Maggie's received 249,247 visits across the network of centres in the UK, Hong Kong and Tokyo. The Maggie's program is designed to incorporate evidence based psychoeducation techniques delivered by multidisciplinary oncology professionals; offer personalised and understandable treatment and lifestyle information; and maximize the opportunity for social-support. Outcome evaluation is embedded within the model of care. Aim: To illustrate the holistic Maggie's model using outcome data from “Managing Stress” and “Living with and after Prostate Cancer (LWAPC)” courses to provide examples of the impact Maggie´s makes in enhancing quality of life. Methods: A subset of participants in “Managing Stress” and “Living with and after Prostate Cancer” courses across the network of UK Maggie´s Centres completed pre and post course standardized questionnaires. Results: Participants in “Managing Stress” found significant improvements in overall psychological well-being and quality of life (QoL) (t(40)=3.28, P = .002) and significant improvements in their ability to tolerate uncertainty (t(47) = 3.23, P = .002). Participants in the LWAPC found significant improvements in overall prostate cancer specific QoL ( t(37)=3.603, P = .001), general well-being ( t(37)=2.61, P = .013), and emotional well-being ( t(37)=2.62, P = .013). Also, significant reductions were found in overall negative appraisal of life (t(52)=2.96, P = .005), overall health worries (t(52) 2.28, P = 0.27), worries about the future (t(52) = 2.85, P = .006) and uncertainty (t(52) = 3.89, P < .001). Conclusion: Globally, the supportive care needs of people affected by cancer are changing but the Maggie's model of care offers valuable lessons that can be generalized across varied support settings to meet these emerging needs.

Social Support and Health-Related Quality of Life Among Gay and Bisexual Men With Prostate Cancer.

To describe social support patterns of gay and bisexual men with prostate cancer (GBMPCa) and how social support is associated with prostate cancer outcomes. A cross-sectional online survey with 186 GBMPCa recruited from a national cancer support group network. Descriptive statistics of social support and linear regression of social support on general and prostate cancer-specific quality of life (QOL). Social support and health-related QOL were assessed generally and specific to prostate cancer. Participants primarily relied on partners or husbands, gay and bisexual friends, chosen family, and men from support groups for support. The most common types of support received were informational and emotional social support. Low general social support was significantly associated with worse prostate cancer symptom bother and general mental QOL. Wanting more social support was significantly associated with worse prostate cancer-specific and general QOL. Clinicians should be aware of the different social support networks and needs of GBMPCa and refer them to relevant support groups to improve QOL.

Abstract C43: Health changes in low-income men transitioning from prostate cancer coverage to comprehensive insurance

Abstract Introduction: The Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT) program was established in 2001 to provide free prostate cancer treatment and care navigation services for uninsured, low-income men in California. Prior work has highlighted the value of IMPACT's services on improving care coordination and mental well-being of enrolled men, as well as facilitating self-efficacy. The shift from IMPACT to comprehensive health insurance under the Patient Protection and Affordable Care Act (ACA) presented an opportunity to study the effects of the transition from a high-touch, disease-focused program to less-individualized but broader coverage. We hypothesized that health-related quality of life (QOL) would decline in men transitioning from IMPACT to comprehensive insurance relative to a group of men who remained in IMPACT. Methods: Concurrent with IMPACT enrollment, men were invited to participate in a longitudinal study of general and prostate cancer-related QOL. Using this data, we compared QOL between men who transitioned from IMPACT to full-scope insurance (n=24, intervention) and those who remained in IMPACT (n=39, control). We used the RAND 12-item short form health survey (SF-12 v2) and UCLA Prostate Cancer Index (PCI) to measure general and prostate cancer-related QOL, respectively. The SF-12 v2 includes a mental composite score, a physical composite score, and a measure of general health, each normalized to the general population. The PCI quantifies function and bother related to urinary, sexual, and bowel habits. Data were collected at baseline (6-16 months before exiting IMPACT), transition (4 months before, to 1 month after exit), and post-transition (10-13 months after exit). Mixed-effects models, controlling for type of and time from definitive treatment (surgery or radiation within 12 months), were used to compare measures between the two groups. Results: Mental, physical, and general health did not differ between the control and intervention groups at baseline. Men who left IMPACT had significantly worse physical health compared to controls at the post-transition time point (p=0.0049). In the mixed-effects model, physical health differed significantly between groups (p=0.0071). Mental health did not. Between the transition and post-transition time points, general health improved significantly in men who left IMPACT (p=0.024), though we found no difference between groups. Prostate cancer-related QOL did not differ over time between the control and intervention groups. Active treatment within one year from the time of data collection was associated with worse sexual bother (p=0.02); otherwise, there were no differences in prostate cancer-related QOL related to receipt of active treatment within one year from time of data collection. Conclusion: Disadvantaged men leaving a prostate-cancer treatment and navigation program for comprehensive insurance under the ACA reported worse physical health after the transition, relative to men staying in the program. Mental well-being and prostate cancer-specific QOL tracked similarly between the groups. Further investigation of the mechanisms underlying the decline in physical health after transitioning from IMPACT to full-scope insurance may provide policy makers with actionable information for newly insured vulnerable populations. Citation Format: Ruby Kuang, Jamal Nabhani, Hui Liu, Lorna Kwan, Mark S. Litwin. Health changes in low-income men transitioning from prostate cancer coverage to comprehensive insurance [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C43.

Impact of resistance training on body composition and metabolic syndrome variables during androgen deprivation therapy for prostate cancer: a pilot randomized controlled trial

BackgroundProstate cancer patients on androgen deprivation therapy (ADT) experience adverse effects such as lean mass loss, known as sarcopenia, fat gain, and changes in cardiometabolic factors that increase risk of metabolic syndrome (MetS). Resistance training can increase lean mass, reduce body fat, and improve physical function and quality of life, but no exercise interventions in prostate cancer patients on ADT have concomitantly improved body composition and MetS. This pilot trial investigated 12 weeks of resistance training on body composition and MetS changes in prostate cancer patients on ADT. An exploratory aim examined if a combined approach of training and protein supplementation would elicit greater changes in body composition.MethodsProstate cancer patients on ADT were randomized to resistance training and protein supplementation (TRAINPRO), resistance training (TRAIN), protein supplementation (PRO), or control stretching (STRETCH). Exercise groups (EXE = TRAINPRO, TRAIN) performed supervised exercise 3 days per week for 12 weeks, while non-exercise groups (NoEXE = PRO, STRETCH) performed a home-based stretching program. TRAINPRO and PRO received 50 g⋅day− 1 of whey protein. The primary outcome was change in lean mass assessed through dual energy x-ray absorptiometry. Secondary outcomes examined changes in sarcopenia, assessed through appendicular skeletal mass (ASM) index (kg/m2), body fat %, strength, physical function, quality of life, MetS score and the MetS components of waist circumference, blood pressure, glucose, high-density lipoprotein-cholesterol, and triglyceride levels.ResultsA total of 37 participants were randomized; 32 participated in the intervention (EXE n = 13; NoEXE n = 19). At baseline, 43.8% of participants were sarcopenic and 40.6% met the criteria for MetS. Post-intervention, EXE significantly improved lean mass (d = 0.9), sarcopenia prevalence (d = 0.8), body fat % (d = 1.1), strength (d = 0.8–3.0), and prostate cancer-specific quality of life (d = 0.9) compared to NoEXE (p < 0.05). No significant differences were observed between groups for physical function or MetS-related variables except waist circumference (d = 0.8).ConclusionsA 12-week resistance training intervention effectively improved sarcopenia, body fat %, strength and quality of life in hypogonadal prostate cancer patients, but did not change MetS or physical function. PRO did not offer additional benefit in improving body composition.Trial registrationClinicalTrials.gov: NCT01909440. Registered 24 July 2013.

Nurse-led group consultation intervention reduces depressive symptoms in men with localised prostate cancer: a cluster randomised controlled trial.

BackgroundRadiotherapy for localised prostate cancer has many known and distressing side effects. The efficacy of group interventions for reducing psychological morbidity is lacking. This study investigated the relative benefits of a group nurse-led intervention on psychological morbidity, unmet needs, treatment-related concerns and prostate cancer-specific quality of life in men receiving curative intent radiotherapy for prostate cancer.MethodsThis phase III, two-arm cluster randomised controlled trial included 331 men (consent rate: 72 %; attrition: 5 %) randomised to the intervention (n = 166) or usual care (n = 165). The intervention comprised four group and one individual consultation all delivered by specialist uro-oncology nurses. Primary outcomes were anxious and depressive symptoms as assessed by the Hospital Anxiety and Depression Scale. Unmet needs were assessed with the Supportive Care Needs Survey-SF34 Revised, treatment-related concerns with the Cancer Treatment Scale and quality of life with the Expanded Prostate Cancer Index −26. Assessments occurred before, at the end of and 6 months post-radiotherapy. Primary outcome analysis was by intention-to-treat and performed by fitting a linear mixed model to each outcome separately using all observed data.ResultsMixed models analysis indicated that group consultations had a significant beneficial effect on one of two primary endpoints, depressive symptoms (p = 0.009), and one of twelve secondary endpoints, procedural concerns related to cancer treatment (p = 0.049). Group consultations did not have a significant beneficial effect on generalised anxiety, unmet needs and prostate cancer-specific quality of life.ConclusionsCompared with individual consultations offered as part of usual care, the intervention provides a means of delivering patient education and is associated with modest reductions in depressive symptoms and procedural concerns. Future work should seek to confirm the clinical feasibility and cost-effectiveness of group interventions.Trial registrationAustralian and New Zealand Clinical Trials Registry ANZCTRN012606000184572. 1 March 2006.

Intensity-Modulated Radiation Therapy with Stereotactic Body Radiation Therapy Boost for Unfavorable Prostate Cancer: The Georgetown University Experience

Stereotactic body radiation therapy (SBRT) is emerging as a minimally invasive alternative to brachytherapy to deliver highly conformal, dose--escalated radiation therapy (RT) to the prostate. SBRT alone may not adequately cover the tumor extensions outside the prostate commonly seen in unfavorable prostate cancer. External beam radiation therapy (EBRT) with high dose rate brachytherapy boost is a proven effective therapy for unfavorable prostate cancer. This study reports on early prostate-specific antigen and prostate cancer-specific quality of life (QOL) outcomes in a cohort of unfavorable patients treated with intensity-modulated radiation therapy (IMRT) and SBRT boost. Prostate cancer patients treated with SBRT (19.5 Gy in three fractions) followed by fiducial-guided IMRT (45-50.4 Gy) from March 2008 to September 2012 were included in this retrospective review of prospectively collected data. Biochemical failure was assessed using the Phoenix definition. Patients completed the expanded prostate cancer index composite (EPIC)-26 at baseline, 1 month after the completion of RT, every 3 months for the first year, then every 6 months for a minimum of 2 years. One hundred eight patients (4 low-, 45 intermediate-, and 59 high-risk) with median age of 74 years completed treatment, with median follow-up of 4.4 years. Sixty-four percent of the patients received androgen deprivation therapy prior to the initiation of RT. The 3-year actuarial biochemical control rates were 100 and 89.8% for intermediate- and high-risk patients, respectively. At the initiation of RT, 9 and 5% of men felt their urinary and bowel function was a moderate to big problem, respectively. Mean EPIC urinary and bowel function and bother scores exhibited transient declines, with subsequent return to near baseline. At 2 years posttreatment, 13.7 and 5% of men felt their urinary and bowel function was a moderate to big problem, respectively. At 3-year follow-up, biochemical control was favorable. Acute urinary and bowel symptoms were comparable to conventionally fractionated IMRT and brachytherapy. Patients recovered to near their baseline urinary and bowel function by 2 years posttreatment. A combination of IMRT with SBRT boost is well tolerated with minimal impact on prostate cancer-specific QOL.

What Is a "Good" Treatment Decision? Decisional Control, Knowledge, Treatment Decision Making, and Quality of Life in Men with Clinically Localized Prostate Cancer.

We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision-making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision making is an advantageous model for studying patient treatment decision-making dynamics because there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Men with newly diagnosed clinically localized prostate cancer (N = 1529) completed measures of decisional control, prostate cancer knowledge, and decision-making experiences (decisional conflict and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed at 6 months after treatment. More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control, predicted better QOL 6 months after treatment. Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time that they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects.

Quality of Life and Safety Outcomes Following Irreversible Electroporation Treatment for Prostate Cancer: Results from a Phase I-Ii Study

Objective: Prostate cancer treatment as radical prostatectomy or radiation therapy is associated with collateral tissue damage resulting inside-effects. Irreversible electroporation is a minimally invasive technique that has shown to be effective in destroying tumour cells and has been proposed to diminish the treatment related morbidity. The aim of the study was to evaluate the safety and quality of life (QoL) and functional outcomes of extended and focal irreversible electroporation (IRE) in prostate cancer. Methods: IRE-ablations of the prostate were performed using two treatment protocols (focal and extended) to assess potential variation in outcomes. The safety of IRE was assessed by the device-related, periprocedural- and post procedural adverse events. Post-procedural quality of life was measured by prostate cancer-specific QoL questionnaires. Several validated questionnaires were used to determine the following outcomes: genitourinary side effects, urinary and erectile function. Post-procedural pain was scored using the visual analogue scale and the length of hospital stay was documented. Results: Mainly mild adverse events (grade 1-2) occurred during the short-term follow-up, mostly concerning lower urinary tract symptoms. Nearly all resolved between the first and fourth week post treatment. Quality of life assessment showed deterioration in the urinary domain for both treatment protocols. Functional outcome questionnaire results remained stable over time. The reported post-procedural pain was low with a median of 0.5 one day post-IRE, and the length of hospital stay was short (mean of 3 days). Analysis per treatment protocol showed a significant increase between one and four weeks post treatment (p=0.03) in the extended treatment group. Conclusion: Irreversible electroporation can be performed safely in patients suffering from prostate cancer. The adverse events are mostly temporary. Quality of life assessment shows deterioration in the urinary domain; however, functional outcomes remain stable over time.

Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen‐deprivation therapy: a randomised controlled trial

To determine if supervised exercise minimises treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy (ADT). This is the first study to date that has investigated the potential role of exercise in preventing ADT toxicity rather than recovering from established toxicities. Sixty-three men scheduled to receive ADT were randomly assigned to a 3-month supervised exercise programme involving aerobic and resistance exercise sessions commenced within 10 days of their first ADT injection (32 men) or usual care (31 men). The primary outcome was body composition (lean and fat mass). Other study outcomes included bone mineral density, physical function, blood biomarkers of chronic disease risk and bone turnover, general and prostate cancer-specific quality of life, fatigue and psychological distress. Outcomes were compared between groups using analysis of covariance adjusted for baseline values. Compared to usual care, a 3-month exercise programme preserved appendicular lean mass (P = 0.019) and prevented gains in whole body fat mass, trunk fat mass and percentage fat with group differences of -1.4 kg (P = 0.001), -0.9 kg (P = 0.008) and -1.3% (P < 0.001), respectively. Significant between-group differences were also seen favouring the exercise group for cardiovascular fitness (peak oxygen consumption 1.1 mL/kg/min, P = 0.004), muscular strength (4.0-25.9 kg, P ≤ 0.026), lower body function (-1.1 s, P < 0.001), total cholesterol: high-density lipoprotein-cholesterol ratio (-0.52, P = 0.028), sexual function (15.2, P = 0.028), fatigue (3.1, P = 0.042), psychological distress (-2.2, P = 0.045), social functioning (3.8, P = 0.015) and mental health (3.6-3.8, P ≤ 0.022). There were no significant group differences for any other outcomes. Commencing a supervised exercise programme involving aerobic and resistance exercise when initiating ADT significantly reduced treatment toxicity, while improving social functioning and mental health. Concurrent prescription of supervised exercise when initiating ADT is therefore advised to minimise morbidity associated with severe hypogonadism.

Protocol for the ProCare Trial: a phase II randomised controlled trial of shared care for follow-up of men with prostate cancer

IntroductionMen with prostate cancer require long-term follow-up to monitor disease progression and manage common adverse physical and psychosocial consequences of treatment. There is growing recognition of the potential role of...

Profile and predictors of global distress: Can the DT guide nursing practice in prostate cancer?

This study examines the ability of the distress thermometer to accurately identify patients with higher symptoms, unmet needs and psychological morbidity. Baseline data collected as part of a randomized controlled trial evaluating a nurse-led supportive care intervention for men with prostate cancer commencing radiotherapy at a specialist cancer hospital in Melbourne, Australia. Measures assessed global distress (DT), anxious and depressive symptomatology (HADS), prostate-cancer specific quality of life (EPIC-26), unmet supportive care needs (SCNS-SF34R) and cancer treatment-related concerns (CATS). Following descriptive and correlational analysis, hierarchical multiple regression was employed to examine the contribution of variable sets to explaining variance in DT scores. Less than 20% of men reported DT scores of 4 or higher, indicating overall low distress. The DT accurately identified almost all men reporting HADS score indicative of anxious or depressive symptomatology, suggesting it accurately identifies psychological morbidity. Importantly, the DT identified a further group of distressed men, not identified by HADS, whose distress related to unmet needs and prostate cancer-specific issues, indicating the DT is superior in identifying other forms of distress. While the hierarchical multiple regression confirmed anxious and depressive symptomatology as the best predictor of distress score, many other scales are also good predictors of DT scores, supporting the argument that distress is multi-determined. Nurses can be confident that the DT accurately identifies patients with psychological morbidity and importantly identifies other patients with distress who may require intervention. A distress score of 4 or higher identified participants with higher physical symptomatology, higher unmet needs, more concerns about treatment and poorer quality of life. The low prevalence of distress reaching cut off scores suggests nurses would not be overwhelmed by the outcomes of screening and could use the score to prioritise the patients who need greater attention at entry to radiotherapy services.

Monitoring Quality of Life Among Prostate Cancer Survivors: The Feasibility of Automated Telephone Assessment

To examine the feasibility of using automated interactive voice response calls to assess prostate cancer survivor quality of life (QOL). In light of an increasing focus on patient-centered outcomes, innovative and efficient approaches to monitor QOL among prostate cancer survivors are increasingly valuable. Forty prostate cancer survivors less than 1 year post-treatment were enrolled at a university-based cancer center clinic from July through August 2011. We adapted the Expanded Prostate Cancer Index Composite (EPIC) survey, a prostate cancer-specific QOL instrument, for use via personal telephone with interactive voice response. We compared written vs interactive voice response EPIC scores across urinary, sexual, bowel, and vitality domains. The median age of respondents was 63 years (range, 41-76 years) and the majority had undergone surgery (97.5%). The entire interactive voice response call was completed by 35 participants (87.5%). Over half of all interactive voice response calls were answered after 2 attempts with a median length of 11.3 minutes. On average, interactive voice response EPIC scores were slightly lower than written scores (-2.1 bowel, P = .05; -4.6 urinary incontinence, P < .01). Test-retest reliability was very high for urinary incontinence (r = .97) and sexual function domains (r = .96). Although mean scores were similar for other domains, their distributions had significant ceiling effects limiting our reliability measure interpretation. Automated interactive voice response calls are a feasible strategy for assessing prostate cancer survivor QOL. Interactive voice response could provide a low cost, sustainable, and systematic approach to measuring patient-centered outcomes, conducting comparative effectiveness research, and monitoring the quality of prostate cancer care.

Mindfulness groups for men with advanced prostate cancer: a pilot study to assess feasibility and effectiveness and the role of peer support

Men diagnosed with advanced prostate cancer experience higher psychological distress and greater unmet supportive care needs than men with localized disease. A mindfulness-based cognitive therapy group intervention was pilot tested for acceptability and effectiveness in this patient group. Nineteen men were initially recruited to three groups and 12 completed final assessments. Outcomes assessed included anxiety, depression, cancer-related distress, prostate cancer-specific quality of life, and mindfulness skills at baseline, immediately, and 3 months post-intervention. Satisfaction measures and in-depth interviews were undertaken post-intervention to describe men's personal experiences of the groups. Significant improvements were observed for anxiety (p = 0.027), avoidance (p = 0.032), and mindfulness skills (p = 0.019), with a trend for a reduction in fear of cancer recurrence (p = 0.062). Effect sizes were moderate to large. A shared group identity, acceptance of, and learning from other group members were key aspects of the group context that contributed to acceptance of progressive disease. Mindfulness-based group interventions appear to have utility in this patient group and show promise for reducing anxiety, avoidance, and fear of cancer recurrence. Peer learning appeared to be helpful in generating acceptance of advancing disease.

前立腺癌患者におけるquality of life（QOL）効用値の評価：QOL効用値指標EQ-5DおよびVASと健康関連QOL質問表SF-36およびEPICとの比較

For the management of patients with localized prostate cancer, a number of therapeutic options are available. To compare the therapeutic modalities, it is important and necessary to evaluate economical aspects based on cost-effectiveness analysis. In addition, the survival time adjusted by quality of life (QOL), quality adjusted life year (QALY), is more reliable than the crude survival time. Thus, the usefulness of the commonly used QOL utility indexes, EuroQol-5D (EQ-5D) and visual analogue scale (VAS, 0-100 points), was investigated in prostate cancer patients. A total of 81 patients with prostate cancer were included. The patients were asked to answer the four sets of questionnaires (EQ-5D, VAS, SF-36 and EPIC). The QOL utility indexes (EQ-5D and VAS) were evaluated in relation to the general and prostate cancer-specific QOL questionnaires (SF-36 and EPIC, respectively). The results of EQ-5D and VAS were significantly correlated to all domains of the general QOL questionnaire (SF-36). On the contrary, no remarkable relationship of EQ-5D and VAS was observed with any domain (urinary, bowel, sexual or hormonal) of the prostate cancer-specific QOL questionnaire (EPIC). There was significant and close correlation between the actual values of VAS and the estimates of VAS calculated from SF-36 data (R = 0.53, p < 0.0001). The QOL utility indexes (EQ-5D and VAS) are pertinent to evaluation of QOL utility index in prostate cancer patients and can be utilized for cost-utility analysis. It is suggested that the accumulated data of SF-36 could be used by conversion to QOL utility index.