Fifteen year quality of life outcomes in men with localised prostate cancer: population based Australian prospective study

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.

Fig 1

Flow diagram showing patient and control participation and follow-up. *Lost to follow-up includes study participants who did not participate in the interview for that year but could have participated in subsequent interview years; controls who were diagnosed with prostate cancer after baseline and who were censored from date of diagnosis (n=35). Lost to follow-up frequencies not available for controls in the time periods preceding years 3 and 10 because controls were not interviewed in those years

Fig 2

Adjusted mean differences between treatment group (purple line) and control group (bold black line) follow‐up quality of life scores from expanded prostate cancer index composite short form, EPIC-26. Controls are the reference group (adjusted mean difference=0). Shading indicates the region outside of which adjusted mean differences exceed the minimally important difference. Minimally important difference limits are calculated as plus or minus one third of the pooled baseline standard deviation of the control group and of the treatment group. Adjusted mean differences are adjusted for baseline age, marital status, having private health insurance, region of residence, income, education, country of birth, comorbidity score, and domain-specific baseline (year 0) quality of life score

Fig 3

Adjusted mean differences between initial treatment group (purple line) and control group (bold black line) follow‐up 12-item Short Form Health Survey (SF-12) scores. Controls are the reference group (adjusted mean difference=0). Shaded region indicates adjusted mean differences within minimally important difference. Minimally important difference limits are calculated as plus or minus one third of the pooled baseline standard deviation of the control group and of the treatment group. Adjusted mean differences are adjusted for the following baseline characteristics: age, marital status, having private health insurance, region of residence, income, education, country of birth, comorbidity score, and domain‐specific baseline (year 0) 12-item Short Form Health Survey score