Sam J Egger1, Ross J Calopedos2, Dianne L O'Connell3, Suzanne K Chambers4, Henry H Woo5, David P Smith6. 1. Cancer Research Division, Cancer Council NSW, NSW, Australia. Electronic address: same@nswcc.org.au. 2. Cancer Research Division, Cancer Council NSW, NSW, Australia; General Surgical Department, Wollongong Hospital, NSW, Australia. 3. Cancer Research Division, Cancer Council NSW, NSW, Australia; School of Public Health, University of Sydney, NSW, Australia; School of Medicine and Public Health, University of Newcastle, NSW, Australia. 4. Menzies Health Institute, Griffith University, QLD, Australia; Cancer Council Queensland, QLD, Australia; Prostate Cancer Foundation of Australia, NSW, Australia; Exercise Medicine Research Institute, Edith Cowan University, WA, Australia; Institute for Resilient Regions, University of Southern Queensland, QLD, Australia. 5. Sydney Adventist Hospital Clinical School, University of Sydney, NSW, Australia; Department of Uro-Oncology, Chris O'Brien Lifehouse, NSW, Australia. 6. Cancer Research Division, Cancer Council NSW, NSW, Australia; School of Public Health, University of Sydney, NSW, Australia; Menzies Health Institute, Griffith University, QLD, Australia.
Abstract
BACKGROUND: Long-term psychological well-being and quality-of-life are important considerations when deciding whether to undergo active treatment for low-risk localised prostate cancer. OBJECTIVE: To assess the long-term effects of active surveillance (AS) and/or watchful waiting (WW) on psychological and quality-of-life outcomes for low-risk localised prostate cancer patients. DESIGN, SETTING, AND PARTICIPANTS: The Prostate Cancer Care and Outcome Study is a population-based prospective cohort study in New South Wales, Australia. Participants for these analyses were low-risk localised prostate cancer patients aged <70 yr at diagnosis and participated in the 10-yr follow-up. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Validated instruments assessed outcomes relating to six health-related quality-of-life and nine psychological domains relevant to prostate cancer patients. Adjusted mean differences (AMDs) in outcome scores between prostate cancer treatment groups were estimated using linear regression. RESULTS AND LIMITATIONS: At 9-11 yr after diagnosis, patients who started AS/WW initially had (1) higher levels of distress and hyperarousal than initial radiation/high-dose-rate brachytherapy patients (AMD=5.9; 95% confidence interval or CI [0.5, 11.3] and AMD=5.4; 95% CI [0.2, 10.5], respectively), (2) higher levels of distress and avoidance than initial low-dose-rate brachytherapy patients (AMD=5.3; 95% CI [0.2, 10.3] and AMD=7.0; 95% CI [0.5, 13.5], respectively), (3) better urinary incontinence scores than initial radical prostatectomy patients (AMD=-9.1; 95% CI [-16.3, -2.0]), and (4) less bowel bother than initial radiation/high-dose-rate brachytherapy patients (AMD=-16.8; 95% CI [-27.6, -6.0]). No other significant differences were found. Limitations include participant attrition, inability to assess urinary voiding and storage symptoms, and nonrandom treatment allocation. CONCLUSIONS: Notwithstanding some long-term differences between AS/WW and various active treatment groups in terms of distress, hyperarousal, avoidance, urinary incontinence, and bowel bother, most long-term outcomes were similar between these groups. PATIENT SUMMARY: This study assessed the long-term psychological and quality-of-life impacts of initially monitoring rather than actively treating low-risk prostate cancer. The results suggest that initial monitoring rather than active treatment has only a minor impact on subsequent long-term psychological and quality-of-life outcomes.
BACKGROUND: Long-term psychological well-being and quality-of-life are important considerations when deciding whether to undergo active treatment for low-risk localised prostate cancer. OBJECTIVE: To assess the long-term effects of active surveillance (AS) and/or watchful waiting (WW) on psychological and quality-of-life outcomes for low-risk localised prostate cancerpatients. DESIGN, SETTING, AND PARTICIPANTS: The Prostate Cancer Care and Outcome Study is a population-based prospective cohort study in New South Wales, Australia. Participants for these analyses were low-risk localised prostate cancerpatients aged <70 yr at diagnosis and participated in the 10-yr follow-up. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Validated instruments assessed outcomes relating to six health-related quality-of-life and nine psychological domains relevant to prostate cancerpatients. Adjusted mean differences (AMDs) in outcome scores between prostate cancer treatment groups were estimated using linear regression. RESULTS AND LIMITATIONS: At 9-11 yr after diagnosis, patients who started AS/WW initially had (1) higher levels of distress and hyperarousal than initial radiation/high-dose-rate brachytherapy patients (AMD=5.9; 95% confidence interval or CI [0.5, 11.3] and AMD=5.4; 95% CI [0.2, 10.5], respectively), (2) higher levels of distress and avoidance than initial low-dose-rate brachytherapy patients (AMD=5.3; 95% CI [0.2, 10.3] and AMD=7.0; 95% CI [0.5, 13.5], respectively), (3) better urinary incontinence scores than initial radical prostatectomy patients (AMD=-9.1; 95% CI [-16.3, -2.0]), and (4) less bowel bother than initial radiation/high-dose-rate brachytherapy patients (AMD=-16.8; 95% CI [-27.6, -6.0]). No other significant differences were found. Limitations include participant attrition, inability to assess urinary voiding and storage symptoms, and nonrandom treatment allocation. CONCLUSIONS: Notwithstanding some long-term differences between AS/WW and various active treatment groups in terms of distress, hyperarousal, avoidance, urinary incontinence, and bowel bother, most long-term outcomes were similar between these groups. PATIENT SUMMARY: This study assessed the long-term psychological and quality-of-life impacts of initially monitoring rather than actively treating low-risk prostate cancer. The results suggest that initial monitoring rather than active treatment has only a minor impact on subsequent long-term psychological and quality-of-life outcomes.
Authors: Veeru Kasivisvanathan; Antti S Rannikko; Marcelo Borghi; Valeria Panebianco; Lance A Mynderse; Markku H Vaarala; Alberto Briganti; Lars Budäus; Giles Hellawell; Richard G Hindley; Monique J Roobol; Scott Eggener; Maneesh Ghei; Arnauld Villers; Franck Bladou; Geert M Villeirs; Jaspal Virdi; Silvan Boxler; Grégoire Robert; Paras B Singh; Wulphert Venderink; Boris A Hadaschik; Alain Ruffion; Jim C Hu; Daniel Margolis; Sébastien Crouzet; Laurence Klotz; Samir S Taneja; Peter Pinto; Inderbir Gill; Clare Allen; Francesco Giganti; Alex Freeman; Stephen Morris; Shonit Punwani; Norman R Williams; Chris Brew-Graves; Jonathan Deeks; Yemisi Takwoingi; Mark Emberton; Caroline M Moore Journal: N Engl J Med Date: 2018-03-18 Impact factor: 176.079
Authors: Eric Adjei Boakye; Kahee A Mohammed; Christian J Geneus; Betelihem B Tobo; Lorinette S Wirth; Lei Yang; Nosayaba Osazuwa-Peters Journal: PLoS One Date: 2018-05-10 Impact factor: 3.240