title: Comprehensive quality-of-life outcomes in the setting of a multidisciplinary, equal access prostate cancer clinic.
abstract: OBJECTIVE
  To identify racial and demographic factors that influence treatment choice and its resulting impact on health-related quality of life (HRQoL) for prostate cancer patients.
  
  
  METHODS
  Patients presenting to an equal access, military, multidisciplinary prostate cancer clinic composed the study group. The Expanded Prostate Cancer Index Composite (EPIC), EPIC Demographic, and Medical Outcomes Study Short Form 36 were the instruments used. Evaluation was performed before treatment and every 3 months after treatment.
  
  
  RESULTS
  The study group comprised 665 patients. Caucasians were 3-fold more likely to choose surgery (radical prostatectomy [RP]) over external beam radiation therapy (EBRT). Patients who earned more than $100,000 annually disproportionately chose RP (P < .0001). Similarly, those having a graduate school degree disproportionally chose RP (P < .0001). Patients undergoing RP had the greatest risk of urinary function decline (P < .0001) and sexual bother (P = .0003). African Americans (AA) had a greater risk of urinary function decline irrespective of treatment choice. Patients undergoing EBRT had equivalent urinary function to expectant management (EM) at 12 months (P < .0001). Brachytherapy was the only treatment that posed an increased risk of urinary bother decline when compared with EM (P = .0217). EBRT alone did not show significant decrement in sexual function when compared with EM.
  
  
  CONCLUSIONS
  RP was chosen by patients of Caucasian ethnicity and patients with higher income and education level, despite providing the greatest risk of HRQoL decline. EBRT had no significant impact on urinary function, sexual function, or sexual bother scores at 12 months. EBRT may be offered to older patients with minimal HRQoL impact. Pretreatment counseling of HRQoL outcomes is essential to overall prostate cancer management.
authors.affiliation: Urology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA. Kevin.rice@amedd.army.mil
authors.forename: Kevin
authors.initials: K
authors.lastname: Rice
authors.forename: Jane
authors.initials: J
authors.lastname: Hudak
authors.forename: Kimberly
authors.initials: K
authors.lastname: Peay
authors.forename: Sally
authors.initials: S
authors.lastname: Elsamanoudi
authors.forename: Judith
authors.initials: J
authors.lastname: Travis
authors.forename: Robbin
authors.initials: R
authors.lastname: Lockhart
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cullen
authors.forename: Libby
authors.initials: L
authors.lastname: Black
authors.forename: Susan
authors.initials: S
authors.lastname: Houge
authors.forename: Stephen
authors.initials: S
authors.lastname: Brassell
mesh_terms: D001741:Black or African American; D000368:Aged; D003657:Decision Making; D004522:Educational Status; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D057240:Patient Preference / Q000208:ethnology; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D044465:White People