Fifteen year quality of life outcomes in men with localized prostate cancer: population based Australian prospective study

1. Men diagnosed with localized prostate cancer have lower self-reported quality of life outcomes, particularly sexual function in those who underwent radical prostatectomy.

2. Mental well-being was similar between men without prostate cancer and men who underwent active surveillance/watchful waiting or low dose rate brachytherapy, as their primary treatment for prostate cancer.

Evidence Rating Level: 2 (Good)

Prostate cancer is the second most prevalent form of cancer among men and fourth most out of all types, with 1.3 million diagnoses in 2018 globally. For the most part however, prostate cancers are diagnosed in first world countries when they are still localized, which have survival rates of 100%, 98%, and 96%, at 5, 10, and 15 years respectively. Although quality of life outcomes in the short-term have been extensively studied for various treatment options, research on long-term outcomes has been lacking. The current longitudinal cohort study, based out of New South Wales, Australia, compared 15 year self-reported quality of life outcomes for men with prostate cancer, compared to age matched controls without prostate cancer. At baseline, the sample consisted of 1642 patients with localized prostate cancer and 495 controls, although after 15 years, 487 patients and 103 controls remained, due to loss of follow-up and death. The study analyzed each patient’s primary treatment options, which included nerve sparing radical prostatectomy (NSRP), non-nerve sparing radical prostatectomy (non-NSRP), androgen deprivation therapy, low dose rate brachytherapy, and active surveillance/watchful waiting. The quality of life outcomes measured related to sexual, urinary, and bowel function. The results showed that for all treatments after 15 years, higher prevalence of erectile dysfunction was reported compared to controls, ranging from 62.3% for the active surveillance/watchful waiting group, to 83.0% in the non-NSRP surgery group (control group prevalence was 42.7%). Additionally, patients in the NSRP or non-NSRP surgery group had the highest rates of urinary incontinence at 15 years compared to controls (NSRP: adjusted mean difference -12.6, 95% CI -16.6 to -8.7; non-NSRP: adjusted mean difference -14.1, 95% CI -18.2 to -10.0). For bowel problems, those who underwent androgen deprivation therapy had the highest prevalence after 15 years (17.8%) compared to the controls (1.9%). Finally, mental well-being was similar to the controls for the active surveillance/watchful waiting and low dose rate brachytherapy groups. Overall, this study demonstrates the importance of considering long-term health outcomes for treating localized prostate cancer, to better inform patient-doctor decision making when weighing the likelihood of survival versus the aggressiveness of treatment.

Click to read the study in BMJ

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