Changes in continence and health-related quality of life after curative treatment and watchful waiting of prostate cancer.

OBJECTIVES: To investigate the long-term changes in health-related quality of life (HRQOL), continence, and sexual function after curative therapy (CT) and watchful waiting (WW) for prostate cancer.
METHODS: A self-reported questionnaire of HRQOL and continence was administered to patients with prostate cancer who were candidates for CT and WW. The questionnaire was re-administered during follow-up. The pretreatment and posttreatment HRQOL burden scores were compared and correlated with the treatment, continence, and sexual function.
RESULTS: Of the 61 patients, 41 chose CT (26 chose prostatectomy and 15 radiotherapy). The average follow-up for the CT patients was 24.3 +/- 13.3 months. The pretreatment incontinence score was 0.38 +/- 0.9 and the HRQOL burden score was 16.3 +/- 8.8 (CT versus WW, P = 0.55). On follow-up, 23 (56%) of 41 CT patients were continent. The HRQOL burden score after treatment was similar between the CT and WW patients (20.4 +/- 9.6 versus 18.4 +/- 9.0, P = 0.45). The continent patients had a significantly lower HRQOL burden compared with the post-CT incontinent patients (17.41 +/- 7.4 versus 24.2 +/- 10.8, P = 0.02). The HRQOL burden score after treatment for CT patients who maintained sexual activity and CT patients who lost their sexual activity was similar (P = 0.28).
CONCLUSIONS: The HRQOL after CT of prostate cancer was related to patients' self-perception of continence. Incontinence, either urinary or fecal, was associated with an increased self-reported HRQOL burden, although reduced sexual function was not associated with such a change. The WW patients maintain their HRQOL. Separating the continent and incontinent patients during the analysis of the posttreatment HRQOL brought to light the adverse outcomes associated with post-CT incontinence.