title: Health-related quality of life 2 years after treatment with radical prostatectomy, prostate brachytherapy, or external beam radiotherapy in patients with clinically localized prostate cancer.
abstract: OBJECTIVE
  To compare treatment impact on health-related quality of life (HRQL) in patients with localized prostate cancer, from before treatment to 2 years after the intervention.
  
  
  METHODS
  This was a longitudinal, prospective study of 614 patients with localized prostate cancer treated with radical prostatectomy (134), three-dimensional external conformal radiotherapy (205), and brachytherapy (275). The HRQL questionnaires administered before and after treatment (months 1, 3, 6, 12, and 24) were the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Association Symptom Index. Differences between groups were tested by analysis of variance and within-group changes by univariate repeated-measures analysis of variance. Generalized estimating equations (GEE) models were constructed to assess between-group differences in HRQL at 2 years of follow-up after adjusting for clinical variables.
  
  
  RESULTS
  In each treatment group, HRQL initially deteriorated after treatment with subsequent partial recovery. However, some dimension scores were still significantly lower after 2 years of treatment. The GEE models showed that, compared with the brachytherapy group, radical prostatectomy patients had worse EPIC sexual summary and urinary incontinence scores (-20.4 and -14.1; p < 0.001), and external radiotherapy patients had worse EPIC bowel, sexual, and hormonal summary scores (-3.55, -5.24, and -1.94; p < 0.05). Prostatectomy patients had significantly better EPIC urinary irritation scores than brachytherapy patients (+4.16; p < 0.001).
  
  
  CONCLUSIONS
  Relevant differences between treatment groups persisted after 2 years of follow-up. Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence. Three-dimensional conformal radiotherapy had a moderate negative impact on bowel functioning, and brachytherapy caused moderate urinary irritation. These results provide relevant information for clinical decision making.
authors.affiliation: Unidad de Investigación en Servicios Sanitarios, IMIM-Hospital del Mar, Barcelona, Spain. mferrer@imim.es
authors.forename: Montserrat
authors.initials: M
authors.lastname: Ferrer
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Suárez
authors.forename: Ferran
authors.initials: F
authors.lastname: Guedea
authors.forename: Pablo
authors.initials: P
authors.lastname: Fernández
authors.forename: Víctor
authors.initials: V
authors.lastname: Macías
authors.forename: Alfonso
authors.initials: A
authors.lastname: Mariño
authors.forename: Asunción
authors.initials: A
authors.lastname: Hervas
authors.forename: Ismael
authors.initials: I
authors.lastname: Herruzo
authors.forename: María José
authors.initials: MJ
authors.lastname: Ortiz
authors.forename: Humberto
authors.initials: H
authors.lastname: Villavicencio
authors.forename: Jordi
authors.initials: J
authors.lastname: Craven-Bratle
authors.forename: Olatz
authors.initials: O
authors.lastname: Garin
authors.forename: Ferran
authors.initials: F
authors.lastname: Aguiló
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D013030:Spain; D011795:Surveys and Questionnaires