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Previous Volume 358:1250-1261 March 20, 2008 Number 12 Next

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ABSTRACT

Background We sought to identify determinants of health-related quality of life after primary treatment of prostate cancer and to measure the effects of such determinants on satisfaction with the outcome of treatment in patients and their spouses or partners.

Methods We prospectively measured outcomes reported by 1201 patients and 625 spouses or partners at multiple centers before and after radical prostatectomy, brachytherapy, or external-beam radiotherapy. We evaluated factors that were associated with changes in quality of life within study groups and determined the effects on satisfaction with the treatment outcome.

Results Adjuvant hormone therapy was associated with worse outcomes across multiple quality-of-life domains among patients receiving brachytherapy or radiotherapy. Patients in the brachytherapy group reported having long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function. Adverse effects of prostatectomy on sexual function were mitigated by nerve-sparing procedures. After prostatectomy, urinary incontinence was observed, but urinary irritation and obstruction improved, particularly in patients with large prostates. No treatment-related deaths occurred; serious adverse events were rare. Treatment-related symptoms were exacerbated by obesity, a large prostate size, a high prostate-specific antigen score, and older age. Black patients reported lower satisfaction with the degree of overall treatment outcomes. Changes in quality of life were significantly associated with the degree of outcome satisfaction among patients and their spouses or partners.

Conclusions Each prostate-cancer treatment was associated with a distinct pattern of change in quality-of-life domains related to urinary, sexual, bowel, and hormonal function. These changes influenced satisfaction with treatment outcomes among patients and their spouses or partners.

Source Information

From the Departments of Surgery (M.G.S.) and Radiation Oncology (I.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, and the Department of Biostatistics (X.L.), School of Public Health, Harvard University, Boston; Biostatistics Core (R.L.D.) and the Departments of Radiation Oncology (H.M.S.) and Urology (D.W., N.S., J.T.W.), School of Medicine, and School of Nursing (L.N.), University of Michigan, Ann Arbor; the Departments of Radiation Oncology (J.M.) and Urology (A.K.), Washington University, St. Louis; the Office for Survey Research, Institute for Public Policy and Social Research, Michigan State University, East Lansing (L.H.); Alcohol Research Group, Public Health Institute, Emeryville, CA (T.K.G.); the Departments of Urology (M.S.L., C.S.S.) and Health Services (M.S.L.), UCLA Center for Health Sciences, Los Angeles; the Departments of Radiation Oncology (A.M., J.C.) and Urology (E.K.), Cleveland Clinic Hospitals, Cleveland; and the Departments of Urology (L.L.P.) and Radiation Oncology (D.K.), M.D. Anderson Cancer Center, Houston.

Address reprint requests to Dr. Sanda at the Division of Urology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Rabb 440, Boston, MA 02215, or at msanda{at}bidmc.harvard.edu.

Full Text of this Article

Related Letters:

Quality of Life and Satisfaction with Outcome among Prostate-Cancer Survivors
Yu J. S., Roach M. III, Arap W., Vordermark D., Sanda M. G., Sandler H. M., Wei J. T.
Extract | Full Text | PDF  
N Engl J Med 2008; 359:200-202, Jul 10, 2008. Correspondence

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