Quality of life and satisfaction with outcome among prostate-cancer survivors.
BACKGROUND
We sought to identify determinants of health-related quality of life after primary treatment of prostate cancer and to measure the effects of such determinants on satisfaction with the outcome of treatment in patients and their spouses or partners.


METHODS
We prospectively measured outcomes reported by 1201 patients and 625 spouses or partners at multiple centers before and after radical prostatectomy, brachytherapy, or external-beam radiotherapy. We evaluated factors that were associated with changes in quality of life within study groups and determined the effects on satisfaction with the treatment outcome.


RESULTS
Adjuvant hormone therapy was associated with worse outcomes across multiple quality-of-life domains among patients receiving brachytherapy or radiotherapy. Patients in the brachytherapy group reported having long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function. Adverse effects of prostatectomy on sexual function were mitigated by nerve-sparing procedures. After prostatectomy, urinary incontinence was observed, but urinary irritation and obstruction improved, particularly in patients with large prostates. No treatment-related deaths occurred; serious adverse events were rare. Treatment-related symptoms were exacerbated by obesity, a large prostate size, a high prostate-specific antigen score, and older age. Black patients reported lower satisfaction with the degree of overall treatment outcomes. Changes in quality of life were significantly associated with the degree of outcome satisfaction among patients and their spouses or partners.


CONCLUSIONS
Each prostate-cancer treatment was associated with a distinct pattern of change in quality-of-life domains related to urinary, sexual, bowel, and hormonal function. These changes influenced satisfaction with treatment outcomes among patients and their spouses or partners.
Sanda
Martin G
MG
Departments of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Harvard University, Boston, MA 02215, USA. msanda@bidmc.harvard.edu
Dunn
Rodney L
RL
Michalski
Jeff
J
Sandler
Howard M
HM
Northouse
Laurel
L
Hembroff
Larry
L
Lin
Xihong
X
Greenfield
Thomas K
TK
Litwin
Mark S
MS
Saigal
Christopher S
CS
Mahadevan
Arul
A
Klein
Eric
E
Kibel
Adam
A
Pisters
Louis L
LL
Kuban
Deborah
D
Kaplan
Irving
I
Wood
David
D
Ciezki
Jay
J
Shah
Nikhil
N
Wei
John T
JT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D001918:Brachytherapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007410:Intestinal Diseases; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D012725:Sexual Behavior; D018454:Spouses / Q000523:psychology; D017741:Survivors / Q000523:psychology; D014555:Urination Disorders
D000726:Androgen Antagonists