ATLANTA, GA USA (UroToday) - Patient reported data from HRQOL studies have demonstrated that all prostate cancer treatments including radical prostatectomy (RP), brachytherapy (PI), and external-beam radiation therapy (EBRT) may negatively impact urinary continence (UC), bowel function and sexual function (SF).
This study assesses the changes that the active surveillance patients experience, over time, relative to the HRQOL parameters.
The data presented is an interim analysis in this prospective longitudinal study. Between 2007 and 2011, 343 patients treated by RP (207), brachytherapy, (64) and active surveillance (72) were enrolled in protocol. Functional outcomes were assessed at baseline, 1, 3, 6, 12, 18 and 24 months using a validated HRQOL instrument (Giesler RB et al. Qual Life Res 2000). Urinary continence was assessed by three questions on frequency, quantity of incontinence and pad usage. Sexual function was assessed by two questions pertaining to quality and frequency of erections. At median follow-up of 24 months, twenty-one (29%) AS patients received treatment by RP (15), PI (5), and EBRT (1).
Forty-four (61%) AS patients underwent at least 2 biopsies on study and 22 (31%) had 3 or more. Patient characteristics at baseline between treatment groups differed with respect to age (P <0.001), clinical stage (P <0.001), biopsy Gleason score (P <0.001), baseline UC (P = 0.013), and baseline SF (P = 0.006). Baseline UC scores for AS, PI, and RP were 3.4, 3.7, and 4.0, respectively with significant differences between AS and RP (P = 0.004). Baseline SF scores for AS, PI, and RP were 7.8, 7.0, and 8.9, respectively, with significant differences between PI and RP (P = 0.003).
In intention-to-treat analyses, baseline and last followup UC and SF were not significantly different in AS patients, but differed among PI and RP patients. At 2 years, the median UC for AS, PI, and RP was 3.7, 4.8, and 6.9, respectively (P < 0.001) and median SF was 7.2, 5.6, and 5.7, respectively (P = 0.033). In multivariable analysis, there was no significant difference in UC (P = 0.5) and SF (P = 0.07) between AS and PI patients, but RP patients had worse UC (P <0.001) and SF (P <0.001) compared to AS.
The authors concluded that UC and SF worsen over time among PI and RP patients, but not among AS patients. When comparing treatments, AS patients have better HRQOL compared to RP patients, but not when compared to PI patients. Information on voiding dysfunction and bowel function is needed to further assess impact of treatments on HRQOL.
Full Title: Urinary continence (UC) and sexual function (SF) among men with localized prostate cancer treated with active surveillance (AS), radical prostatectomy (RP), and brachytherapy (PI): Interim results of a prospective, longitudinal health-related quality-of-life (HRQOL) study
Presented by Kiranpreet K. Khurana, Joseph C. Klink, Li Jianbo, Tracy L. Krebs, Donna J. Prots, Brandon K. Isariyawongse, J. Stephen Jones, Jay P. Ciezki, Eric C. Klein, and Andrew J. Stephenson at the American Urological Association (AUA) Annual Meeting - May 19 - 23, 2012 - Georgia World Congress Center - Atlanta, GA USA
