Quality of life three years after diagnosis of localised prostate cancer: population based cohort study.
OBJECTIVE
To quantify the risk and severity of negative effects of treatment for localised prostate cancer on long term quality of life.


METHODS
Population based, prospective cohort study with follow-up over three years.


METHODS
New South Wales, Australia.


METHODS
Men with localised prostate cancer were eligible if aged less than 70 years, diagnosed between October 2000 and October 2002, and notified to the New South Wales central cancer registry. Controls were randomly selected from the New South Wales electoral roll and matched to cases by age and postcode.


METHODS
General health specific and disease specific function up to three years after diagnosis, according to the 12 item short form health survey and the University of California, Los Angeles prostate cancer index.


RESULTS
1642 (64%) cases and 495 (63%) eligible and contacted controls took part in the study. After adjustment for confounders, all active treatment groups had low odds of having better sexual function than controls, in particular men on androgen deprivation therapy (adjusted odds ratio (OR) 0.02, 95% CI 0.01 to 0.07). Men treated surgically reported the worst urinary function (adjusted OR 0.17, 95% CI 0.13 to 0.22). Bowel function was poorest in cases who had external beam radiotherapy (adjusted OR 0.44, 95% CI 0.30 to 0.64). General physical and mental health scores were similar across treatment groups, but poorest in men who had androgen deprivation therapy.


CONCLUSIONS
The various treatments for localised prostate cancer each have persistent effects on quality of life. Sexual dysfunction three years after diagnosis was common in all treatment groups, whereas poor urinary function was less common. Bowel function was most compromised in those who had external beam radiotherapy. Men with prostate cancer and the clinicians who treat them should be aware of the effects of treatment on quality of life, and weigh them up against the patient's age and the risk of progression of prostate cancer if untreated to make informed decisions about treatment.
Smith
David P
DP
Cancer Council, Kings Cross, New South Wales 1340, Australia. dsmith@nswcc.org.au
King
Madeleine T
MT
Egger
Sam
S
Berry
Martin P
MP
Stricker
Phillip D
PD
Cozzi
Paul
P
Ward
Jeanette
J
O'Connell
Dianne L
DL
Armstrong
Bruce K
BK
D000328:Adult; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D001918:Brachytherapy / Q000706:statistics & numerical data; D016022:Case-Control Studies; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011468:Prostatectomy / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000628:therapy; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology
D000726:Androgen Antagonists