FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

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

	Full Text PDF PDA Full Text PowerPoint Slide Set CME Exam Supplementary Material Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear

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

This article has been cited by other articles:

• Shappley, W. V. III, Kenfield, S. A., Kasperzyk, J. L., Qiu, W., Stampfer, M. J., Sanda, M. G., Chan, J. M. (2009). Prospective Study of Determinants and Outcomes of Deferred Treatment or Watchful Waiting Among Men With Prostate Cancer in a Nationwide Cohort. JCO 27: 4980-4985 [Abstract] [Full Text]  
• Zietman, A. (2009). Evidence-Based Medicine, Conscience-Based Medicine, and the Management of Low-Risk Prostate Cancer. JCO 27: 4935-4936 [Full Text]  
• Stephenson, A. J., Kattan, M. W., Eastham, J. A., Bianco, F. J. Jr, Yossepowitch, O., Vickers, A. J., Klein, E. A., Wood, D. P., Scardino, P. T. (2009). Prostate Cancer-Specific Mortality After Radical Prostatectomy for Patients Treated in the Prostate-Specific Antigen Era. JCO 27: 4300-4305 [Abstract] [Full Text]  
• D'Amico, A. V., Moran, B. J., Braccioforte, M. H., Dosoretz, D., Salenius, S., Katin, M., Ross, R., Chen, M.-H. (2009). Risk of Death From Prostate Cancer After Brachytherapy Alone or With Radiation, Androgen Suppression Therapy, or Both in Men With High-Risk Disease. JCO 27: 3923-3928 [Abstract] [Full Text]  
• Chen, R. C., Clark, J. A., Talcott, J. A. (2009). Individualizing Quality-of-Life Outcomes Reporting: How Localized Prostate Cancer Treatments Affect Patients With Different Levels of Baseline Urinary, Bowel, and Sexual Function. JCO 27: 3916-3922 [Abstract] [Full Text]  
• Hashine, K., Kusuhara, Y., Miura, N., Shirato, A., Sumiyoshi, Y., Kataoka, M. (2009). Health-related Quality of Life using SF-8 and EPIC Questionnaires after Treatment with Radical Retropubic Prostatectomy and Permanent Prostate Brachytherapy. Jpn J Clin Oncol 39: 502-508 [Abstract] [Full Text]  
• Alibhai, S. M.H., Duong-Hua, M., Sutradhar, R., Fleshner, N. E., Warde, P., Cheung, A. M., Paszat, L. F. (2009). Impact of Androgen Deprivation Therapy on Cardiovascular Disease and Diabetes. JCO 27: 3452-3458 [Abstract] [Full Text]  
• Gore, J. L., Kwan, L., Lee, S. P., Reiter, R. E., Litwin, M. S. (2009). Survivorship Beyond Convalescence: 48-Month Quality-of-Life Outcomes After Treatment for Localized Prostate Cancer. JNCI J Natl Cancer Inst 101: 888-892 [Abstract] [Full Text]  
• Goodwin, P. J., Sridhar, S. S. (2009). Health-Related Quality of Life in Cancer Patients--More Answers but Many Questions Remain. JNCI J Natl Cancer Inst 101: 838-839 [Full Text]  
• Sanda, M. G., Kaplan, I. D. (2009). A 64-Year-Old Man With Low-Risk Prostate Cancer: Review of Prostate Cancer Treatment. JAMA 301: 2141-2151 [Abstract] [Full Text]  
• Porta, M. G. D., Malcovati, L. (2009). Clinical relevance of extra-hematologic comorbidity in the management of patients with myelodysplastic syndrome. haematol 94: 602-606 [Full Text]  
• Kilbridge, K. L., Fraser, G., Krahn, M., Nelson, E. M., Conaway, M., Bashore, R., Wolf, A., Barry, M. J., Gong, D. A., Nease, R. F. Jr, Connors, A. F. (2009). Lack of Comprehension of Common Prostate Cancer Terms in an Underserved Population. JCO 27: 2015-2021 [Abstract] [Full Text]  
• Simon, M. A., Dong, X., Nonzee, N., Bennett, C. L. (2009). Heeding Our Words: Complexities of Research Among Low-Literacy Populations. JCO 27: 1938-1940 [Full Text]  
• Dale, W., Hemmerich, J., Bylow, K., Mohile, S., Mullaney, M., Stadler, W. M. (2009). Patient Anxiety About Prostate Cancer Independently Predicts Early Initiation of Androgen Deprivation Therapy for Biochemical Cancer Recurrence in Older Men: A Prospective Cohort Study. JCO 27: 1557-1563 [Abstract] [Full Text]  
• King, J. W., Thomas, S., Corsi, F., Gao, L., Dina, R., Gillmore, R., Pigott, K., Kaisary, A., Stauss, H. J., Waxman, J. (2009). IL15 Can Reverse the Unresponsiveness of Wilms' Tumor Antigen-Specific CTL in Patients with Prostate Cancer. Clin. Cancer Res. 15: 1145-1154 [Abstract] [Full Text]  
• Montie, J. E., Carducci, M. A., Kuban, D. A. (2009). Perspectives on the Management of Localized Prostate Cancer: Focus on Radiotherapy. Am Soc Clin Oncol Ed Book 2009: 270-274 [Abstract] [Full Text]  
• Lustberg, M., Shapiro, C. L. (2009). Physical Challenges of Adult Cancer Survivors. Am Soc Clin Oncol Ed Book 2009: 564-569 [Abstract] [Full Text]  
• (2008). Management of Prostate Cancer. NEJM 359: 2605-2609 [Full Text]  
• Yu, J. S., Roach, M. III, Arap, W., Vordermark, D., Sanda, M. G., Sandler, H. M., Wei, J. T. (2008). Quality of Life and Satisfaction with Outcome among Prostate-Cancer Survivors. NEJM 359: 200-202 [Full Text]  
• Bhatia, S., Robison, L. L. (2008). Cancer Survivorship Research: Opportunities and Future Needs for Expanding the Research Base. Cancer Epidemiol. Biomarkers Prev. 17: 1551-1557 [Full Text]  
• (2008). Quality of Life Following Primary Therapy for Prostate Cancer. JWatch Oncology and Hematology 2008: 3-3 [Full Text]