Quality-of-life outcomes for men with prostate carcinoma detected by screening.
BACKGROUND
There is limited information on outcomes of prostate carcinoma treatments given to screened patient populations for whom cancer is usually detected at an earlier stage.


METHODS
The authors conducted a cross-sectional evaluation of quality-of-life outcomes for men with prostate carcinoma detected in screening studies at a university center. Of 2234 men diagnosed with prostate carcinoma between 1989 and 1997, 74% responded to the questionnaire. Primary management included radical prostatectomy (76%), radiotherapy (11%), observation (7%), hormonal therapy (4%), and cryoablation (2%). Main outcome measures included validated measurements of quality of life, urinary and sexual functioning, and bother (36-item RAND Health Survey, UCLA Prostate Cancer Index).


RESULTS
After controlling for demographic factors, differences among treatment groups were found for all general quality-of-life outcomes, with increased impairment in men who underwent hormonal therapy (all P values <0.05). Urinary and sexual function and bother were also significantly related to treatment. However, among men followed for > or =12 months, only 9% reported a moderate or major problem with urinary control. Sexual functioning was a moderate or major problem following treatment for 58% treated with prostatectomy, 48% treated with radiotherapy, 64% treated with hormonal therapy, 45% treated with cryoablation, and 30% managed with observation. Approximately one-third of the men younger than 70 years who underwent radical prostatectomy maintained adequate sexual functioning posttreatment.


CONCLUSIONS
Up to 6 years after diagnosis, the majority of men with prostate carcinoma detected by screening were bothered by their current sexual function, regardless of treatment. In contrast, most men were not bothered by their current urinary function.
Smith
D S
DS
Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Carvalhal
G F
GF
Schneider
K
K
Krygiel
J
J
Yan
Y
Y
Catalona
W J
WJ
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001294:Attitude to Health; D002277:Carcinoma / Q000175:diagnosis / Q000523:psychology* / Q000532:radiotherapy / Q000628:therapy; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003452:Cryosurgery / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000532:radiotherapy / Q000628:therapy; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D016896:Treatment Outcome; D014555:Urination Disorders / Q000209:etiology
D018931:Antineoplastic Agents, Hormonal