title: Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life changes after radical prostatectomy, external radiation, and brachytherapy.
abstract: OBJECTIVE
  We sought to elucidate long-term changes in health-related quality-of-life (HRQOL) outcomes by prospectively re-evaluating a well-characterized cohort of prostate cancer (PC) survivors 4 to 8 years after primary treatment.
  
  
  METHODS
  Patients who had been evaluated previously at a median of 2.6 years after radical prostatectomy (RP), external radiation (three-dimensional conformal radiation therapy [3-D CRT]), or brachytherapy (BT) were recontacted at a median of 6.2 years after treatment. The clinical relevance of long-term HRQOL impairment among survivors was established by comparison with controls of similar age. Factors associated with HRQOL changes during this interval were evaluated.
  
  
  RESULTS
  Of the 964 eligible men, 709 (73.5%) completed measurable questionnaires. In four domains (urinary irritative-obstructive, urinary incontinence, bowel, and sexual), significant HRQOL differences were detected for at least one of the therapy groups, compared with controls (all P < .05). During the 4-year interval, significant improvement was observed for the urinary irritative-obstructive (P < .0001) and bowel (P < .0001) domains among BT patients, whereas urinary incontinence HRQOL worsened for both the BT (P = .0017) and 3-D CRT (P = .0008) treatment groups. Overall sexual HRQOL deteriorated for the 3-D CRT cohort (P = .0017), as well as for controls (P = .0136). Among RP patients, significant HRQOL changes were not observed.
  
  
  CONCLUSIONS
  During a 4-year interval from earlier to longer-term phases of PC treatment survivorship, sexual, urinary, and bowel dysfunction remain significant concerns among early-stage PC treatment survivors, compared with control men. Although postprostatectomy HRQOL remains relatively stable during this interval, disease-specific HRQOL continues to evolve among men treated with BT and 3-D CRT.
authors.affiliation: Department of Urology, University of Michigan Medical Center, Ann Arbor, MI, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.forename: Martin G
authors.initials: MG
authors.lastname: Sanda
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.forename: Hector
authors.initials: H
authors.lastname: Pimentel
authors.forename: Howard M
authors.initials: HM
authors.lastname: Sandler
authors.forename: William P
authors.initials: WP
authors.lastname: McLaughlin
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D016022:Case-Control Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D011788:Quality of Life; D011832:Radiation Injuries; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D017741:Survivors; D016896:Treatment Outcome; D014549:Urinary Incontinence