Patients' perceptions of quality of life after treatment for early prostate cancer.
OBJECTIVE
Treatment for early prostate cancer produces problematic physical side effects, but prior studies have found little influence on patients' perceived health status. We examined psychosocial outcomes of treatment for early prostate cancer.


METHODS
Patients with previously treated prostate cancer and a reference group of men with a normal prostate-specific antigen (PSA) level and no history of prostate cancer completed questionnaires. Innovative scales assessed behavioral consequences of urinary dysfunction, sexuality, health worry, PSA concern, perceived cancer control, treatment decision making, decision regret, and cancer-related outlook. Urinary, bowel, and sexual dysfunction were assessed with symptom indexes; health status was assessed by the Physical and Mental Summaries of the Short Form (SF-12) Health Survey.


RESULTS
Compared with men without prostate cancer, prostate cancer patients reported greater urinary, bowel, and sexual dysfunction, but similar health status. They reported worse problems of urinary control, sexual intimacy and confidence, and masculinity, and greater PSA concern. Perceptions of cancer control and treatment decisions were positive, but varied by treatment: prostatectomy patients indicated the highest and observation patients indicated the lowest cancer control. Bowel and sexual dysfunction were associated with poorer sexual intimacy, masculinity, and perceived cancer control; masculinity and PSA concern were associated with greater confidence in treatment choice; and diminished sexual intimacy and less interest in PSA were associated with greater regret.


CONCLUSIONS
The lack of change in global measures of health status after treatment for early prostate cancer obscures important influences in men's lives; cancer diagnosis and treatment complications may result in complex outcomes. Aggressive treatment may confer confidence in cancer control, yet be countered by diminished intimate relationships and masculinity, which accompany sexual dysfunction.
Clark
Jack A
JA
Department of Health Services, Boston University School of Public Health, Boston, MA 02118, USA. jaclark@bu.edu
Inui
Thomas S
TS
Silliman
Rebecca A
RA
Bokhour
Barbara G
BG
Krasnow
Steven H
SH
Robinson
Richard A
RA
Spaulding
Monica
M
Talcott
James A
JA
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001918:Brachytherapy; D005242:Fecal Incontinence / Q000209:etiology; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D017430:Prostate-Specific Antigen; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000628:therapy; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D019529:Sexuality; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000209:etiology
D017430:Prostate-Specific Antigen