title: Quality of life impact of treatments for localized prostate cancer: cohort study with a 5 year follow-up.
abstract: OBJECTIVE
  To assess long-term quality of life (QoL) impact of treatments in localized prostate cancer patients treated with radical prostatectomy, external beam radiotherapy or brachytherapy.
  
  
  METHODS
  Observational, prospective cohort study with pre-treatment QoL evaluation and follow-up until five years after treatment. 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited in 2003-2005. QoL was measured by the EPIC questionnaire, with urinary irritative-obstructive, incontinence, bowel, sexual, and hormonal scores (ranging 0-100).
  
  
  RESULTS
  Brachytherapy's QoL impact was restricted to the urinary domain, Generalized Estimating Equation models showed score changes at five years of -12.0 (95% CI=-15.0, -9.0) in incontinence and -5.3 (95% CI=-7.5, -3.1) in irritative-obstructive scales. Compared to brachytherapy, radical prostatectomy fared +3.3 (95% CI=+0.0, +6.5) points better in irritative-obstructive but -17.1 (95% CI=-22.7, -11.5) worse in incontinence. Sexual deterioration was observed in radical prostatectomy (-19.1; 95% CI=-25.1, -13.1) and external radiotherapy groups (-7.5; 95% CI=-12.5, -2.5).
  
  
  CONCLUSIONS
  Brachytherapy is the treatment causing the least impact on QoL except for moderate urinary irritative-obstructive symptoms. Our study provides novel long-term valuable information for clinical decision making, supporting brachytherapy as a possible alternative to radical prostatectomy for patients seeking an attempted curative treatment, while limiting the risk for urinary incontinence and sexual impact on QoL.
authors.affiliation: Health Services Research Unit, IMIM (Hospital del Mar Research Institute), Barcelona, , Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain. Electronic address: mferrer@imim.es.
authors.forename: Montse
authors.initials: M
authors.lastname: Ferrer
authors.forename: Ferran
authors.initials: F
authors.lastname: Guedea
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Suárez
authors.forename: Belén
authors.initials: B
authors.lastname: de Paula
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: Hervás
authors.forename: Ismael
authors.initials: I
authors.lastname: Herruzo
authors.forename: María José
authors.initials: MJ
authors.lastname: Ortiz
authors.forename: Javier
authors.initials: J
authors.lastname: Ponce de León
authors.forename: Gemma
authors.initials: G
authors.lastname: Sancho
authors.forename: Ana
authors.initials: A
authors.lastname: Boladeras
authors.forename: Adriana
authors.initials: A
authors.lastname: Ayala
authors.forename: Jordi
authors.initials: J
authors.lastname: Craven-Bratle
authors.forename: Mónica
authors.initials: M
authors.lastname: Ávila
authors.forename: Oriol
authors.initials: O
authors.lastname: Cunillera
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Pardo
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.forename: Ferran
authors.initials: F
authors.lastname: Aguiló
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000523:psychology* / Q000532:radiotherapy* / Q000601:surgery; D011788:Quality of Life; D011829:Radiation Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000379:methods; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology
keywords: EPIC; External beam radiotherapy; Prostate brachytherapy; Quality of life; Radical prostatectomy