Understanding the Long-Term Impact of Prostate Cancer Treatment on Quality of Life

Understanding the Long-Term Impact Prostate Cancer Treatment on Quality of Life

A new study published in Cancer Medicine examined the long-term health-related effects of definitive treatment for patients with localized prostate cancer and found that they continue more than 10 years after treatment.

Researchers from Massachusetts General Hospital (Mass General) in Boston assessed urinary, bowel, and sexual quality of life of patients who either received radical prostatectomy (RP), external beam radiation therapy (EBRT) or brachytherapy (BT).

"This is one of the few prospective reports on quality of life for prostate cancer patients beyond 10 years, and adds information about the late consequences of treatment choices," noted the authors.

Initial recruitment occurred between 1994 and 2000 when untreated patients were seen for the first time at Mass General, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Beth-Israel Deaconess Medical Center, or Metro West Medical Center. Urinary, bowel, and sexual function were measured at baseline, and then at 3, 12, 24, and 36 months after treatment.

A follow-up survey was mailed to 230 patients who were diagnosed 14 to 18 years earlier. Of those, 211 responded, a response rate of 92%: 42% had had RP, 30% had EBRT and 20% had low-dose-rate BT. Nine percent of the patients who received EBRT also had a BT boost. The median follow-up was 14.6 years after diagnosis.

The remaining 8% of patients in the study underwent observation or had other primary treatment like cryotherapy or androgen deprivation therapy. However, due to the small number, these patients were excluded in the latest report.

Researchers examined the results of 194 patients and found that compared with baseline results, patients who were treated with RP had significantly worse urinary incontinence and sexual function. Patients treated with EBRT had worse scores in all domains, and patients treated with BT had worse urinary incontinence, urinary irritation/obstruction and sexual function.

When comparing treatment groups, RP patients underwent larger declines in urinary continence than did BT patients, and EBRT and BT patients experienced larger changes in urinary irritation/obstruction.

The authors noted that race was significantly associated with a higher urinary obstruction change score, and increased age at baseline was significantly associated with a higher sexual function change.

Patients reported their side effects on the Prostate Cancer Symptom Indices, the Expanded Prostate Index Composite and the Physical Component Summary and Mental Component Summary of the 12-Item Short Form Health Survey.

To conclude, the authors said that all 3 treatment options have long-term side effects that differ. They added, "This study will hopefully inform patients as to what to expect in their second decade of life after treatment, and help each person choose the best treatment option according to their personal needs and objectives."

Jang JW, Drumm MR, Efstathiou JA, et al. Long-term quality of life after definitive treatment for prostate cancer: patient-reported outcomes in the second posttreatment decade [published online ahead of print May 31, 2017]. Cancer Med.