Fifteen year quality of life outcomes in men with localised prostate cancer: population based Australian prospective study [局部性前列腺癌患者的15年生活质量结局：基于澳大利亚人群的前瞻性研究]

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BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3503 (Published 07 October 2020)
Cite this as: BMJ 2020;371:m3503

Authors
Carolyn G Mazariego, Sam Egger, Madeleine T King, Ilona Juraskova, Henry Woo, Martin Berry, Bruce K Armstrong, David P Smith

Abstract
Objective To assess treatment related changes in quality of life up to 15 years after diagnosis of localised prostate cancer.

Design Population based, prospective cohort study with follow-up over 15 years.

Setting New South Wales, Australia.

Participants 1642 men with localised prostate cancer, aged less than 70, and 786 controls randomly recruited from the New South Wales electoral roll into the New South Wales Prostate Cancer Care and Outcomes Study (PCOS).

Main outcome measures General health and disease specific quality of life were self-reported at seven time points over a 15 year period, using the 12-item Short Form Health Survey scale, University of California, Los Angeles prostate cancer index, and expanded prostate cancer index composite short form (EPIC-26). Adjusted mean differences were calculated with controls as the comparison group. Clinical significance of adjusted mean differences was assessed by the minimally important difference, defined as one third of the standard deviation (SD) from the baseline score.

Results At 15 years, all treatment groups reported high levels of erectile dysfunction, depending on treatment (62.3% (active surveillance/watchful waiting, n=33/53) to 83.0% (non-nerve sparing radical prostatectomy, n=117/141)) compared with controls (42.7% (n=44/103)). Men who had external beam radiation therapy or high dose rate brachytherapy or androgen deprivation therapy as primary treatment reported more bowel problems. Self-reported urinary incontinence was particularly prevalent and persistent for men who underwent surgery, and an increase in urinary bother was reported in the group receiving androgen deprivation therapy from 10 to 15 years (year 10: adjusted mean difference −5.3, 95% confidence interval −10.8 to 0.2; year 15: −15.9; −25.1 to −6.7).

Conclusions Patients receiving initial active treatment for localised prostate cancer had generally worse long term self-reported quality of life than men without a diagnosis of prostate cancer. Men treated with radical prostatectomy faired especially badly, particularly in relation to long term sexual outcomes. Clinicians and patients should consider these long term quality of life outcomes when making treatment decisions.