title: Survivorship beyond convalescence: 48-month quality-of-life outcomes after treatment for localized prostate cancer.
abstract: Decision making for treatment of localized prostate cancer is often guided by therapeutic side-effect profiles. We sought to assess health-related quality-of-life outcomes for patients 48 months after treatment for localized prostate cancer. Men treated for localized prostate cancer (N = 475) were evaluated before treatment and at 11 intervals during the 48 months after intervention. Changes in mean health-related quality-of-life scores and the probability of regaining baseline levels of health-related quality of life were compared between treatment groups. All statistical tests were two-sided. Urinary incontinence was more common after prostatectomy (n = 307) than after brachytherapy (n = 90) or external beam radiation therapy (n = 78) (both P < .001), whereas voiding and storage urinary symptoms were more prevalent after brachytherapy than after prostatectomy (both P < .001). Sexual dysfunction profoundly affected all three treatment groups, with a lower likelihood of regaining baseline function after prostatectomy than after external beam radiation therapy or brachytherapy (P < .001). Bowel dysfunction was more common after either form of radiation therapy than after prostatectomy. These results may guide decision making for treatment selection and clinical management of patients with health-related quality-of-life impairments after treatment for localized prostate cancer.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, 911 Broxton Avenue, Los Angeles, CA 90024, USA. jgore@mednet.ucla.edu
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.forename: Steve P
authors.initials: SP
authors.lastname: Lee
authors.forename: Robert E
authors.initials: RE
authors.lastname: Reiter
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D004522:Educational Status; D007172:Erectile Dysfunction / Q000209:etiology; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology