Lindsay A Hampson1, Janet E Cowan2, Shoujun Zhao2, Peter R Carroll2, Matthew R Cooperberg3. 1. Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA. 2. Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA. 3. Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA. Electronic address: mcooperberg@urology.ucsf.edu.
Abstract
BACKGROUND: Men aged >65 yr are less likely to receive local therapy for prostate cancer (PCa), perhaps because of concerns about quality-of-life (QOL) outcomes. OBJECTIVE: To describe QOL before and after PCa treatment in men of varying ages. DESIGN, SETTING, AND PARTICIPANTS: Participants enrolled in CaPSURE who underwent radical prostatectomy, brachytherapy, external beam radiation, androgen deprivation therapy, or active surveillance for localized PCa. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: QOL changes over time were assessed among age groups using repeated-measures mixed models adjusted for race, year, clinical risk, treatment, comorbidities, and an age-time interaction term. Differences are reported as adjusted least-square means and percentage decline. Secondary analyses evaluated age and QOL for local (prostatectomy, radiation) compared to nonlocal treatment (hormonal, surveillance). RESULTS AND LIMITATIONS: Older men had lower mean unadjusted pre- and post-treatment QOL scores for nearly all domains. Of the domains evaluated, adjusted mean sexual function, sexual bother, and urinary function showed greater declines from baseline to 2 yr. At 2 yr, more men <60 yr than those >70 yr experienced declines in urinary function (14% vs 9%) and sexual bother (39% vs 17%). Declines in these domains were also greater for local than for nonlocal treatment. CONCLUSIONS: Definitive treatment for localized disease should not be deferred for older men because of fears regarding QOL declines. Younger men should be counseled about potential post-treatment declines in QOL despite higher absolute QOL scores. Communicating these differences to patients will facilitate more appropriate treatment decision-making in men of all ages. PATIENT SUMMARY: In this study we evaluated quality of life before and after treatment for localized prostate cancer in a diverse patient population. Declines in quality of life after treatment varied according to age and treatment. We conclude that counseling about quality of life will help patients of all ages to make more appropriate treatment decisions.
BACKGROUND:Men aged >65 yr are less likely to receive local therapy for prostate cancer (PCa), perhaps because of concerns about quality-of-life (QOL) outcomes. OBJECTIVE: To describe QOL before and after PCa treatment in men of varying ages. DESIGN, SETTING, AND PARTICIPANTS: Participants enrolled in CaPSURE who underwent radical prostatectomy, brachytherapy, external beam radiation, androgen deprivation therapy, or active surveillance for localized PCa. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: QOL changes over time were assessed among age groups using repeated-measures mixed models adjusted for race, year, clinical risk, treatment, comorbidities, and an age-time interaction term. Differences are reported as adjusted least-square means and percentage decline. Secondary analyses evaluated age and QOL for local (prostatectomy, radiation) compared to nonlocal treatment (hormonal, surveillance). RESULTS AND LIMITATIONS: Older men had lower mean unadjusted pre- and post-treatment QOL scores for nearly all domains. Of the domains evaluated, adjusted mean sexual function, sexual bother, and urinary function showed greater declines from baseline to 2 yr. At 2 yr, more men <60 yr than those >70 yr experienced declines in urinary function (14% vs 9%) and sexual bother (39% vs 17%). Declines in these domains were also greater for local than for nonlocal treatment. CONCLUSIONS: Definitive treatment for localized disease should not be deferred for older men because of fears regarding QOL declines. Younger men should be counseled about potential post-treatment declines in QOL despite higher absolute QOL scores. Communicating these differences to patients will facilitate more appropriate treatment decision-making in men of all ages. PATIENT SUMMARY: In this study we evaluated quality of life before and after treatment for localized prostate cancer in a diverse patient population. Declines in quality of life after treatment varied according to age and treatment. We conclude that counseling about quality of life will help patients of all ages to make more appropriate treatment decisions.
Authors: Peter A Elliott; George A Abdelsayed; Patrick S Kilday; Brian J Kim; Jeff M Slezak; Gary W Chien Journal: World J Urol Date: 2017-10-30 Impact factor: 4.226
Authors: Robin Wm Vernooij; Michelle Lancee; Anne Cleves; Philipp Dahm; Chris H Bangma; Katja Kh Aben Journal: Cochrane Database Syst Rev Date: 2020-06-04
Authors: Caroleen W Quach; Michelle M Langer; Ronald C Chen; David Thissen; Deborah S Usinger; Marc A Emerson; Bryce B Reeve Journal: Qual Life Res Date: 2016-05-30 Impact factor: 4.147
Authors: Michael S Leapman; Janet E Cowan; Hao G Nguyen; Katsuto K Shinohara; Nannette Perez; Matthew R Cooperberg; William J Catalona; Peter R Carroll Journal: J Clin Oncol Date: 2017-03-27 Impact factor: 44.544
Authors: Salome Adam; Daniela Doege; Lena Koch-Gallenkamp; Melissa S Y Thong; Heike Bertram; Andrea Eberle; Bernd Holleczek; Ron Pritzkuleit; Mechthild Waldeyer-Sauerland; Annika Waldmann; Sylke Ruth Zeissig; Lina Jansen; Sabine Rohrmann; Hermann Brenner; Volker Arndt Journal: Support Care Cancer Date: 2019-11-18 Impact factor: 3.603
Authors: Aaron A Laviana; Zhiguo Zhao; Li-Ching Huang; Tatsuki Koyama; Ralph Conwill; Karen Hoffman; Michael Goodman; Ann S Hamilton; Xiao-Cheng Wu; Lisa E Paddock; Antoinette Stroup; Matthew R Cooperberg; Mia Hashibe; Brock B O'Neil; Sherrie H Kaplan; Sheldon Greenfield; David F Penson; Daniel A Barocas Journal: Eur Urol Date: 2020-02-22 Impact factor: 20.096