title: Impact on quality of life of radical prostatectomy after initial active surveillance: more to lose?
abstract: OBJECTIVE
  The aim of this study was to determine whether deferred radical therapy for low-risk prostate cancer has an additionally unfavourable effect on quality of life (QoL). Substantial numbers of patients on active surveillance (AS) are eventually treated.
  
  
  METHODS
  Prostate cancer patients treated with robot-assisted radical prostatectomy (RARP) in the NCI-AvL (Amsterdam, The Netherlands) received systematic QoL questionnaires preoperatively and postoperatively. Questionnaires included the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core Module and Prostate Module (EORTC-QLQ-C30 and EORTC-QLQ-PR25), International Index of Erectile Function-15 (IIEF-15) and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). Patients with low-risk prostate cancer who received RARP after an initial period of AS (AS-RARP group) were compared with similar patients who primarily elected surgery (direct-RARP group).
  
  
  RESULTS
  The AS-RARP group included 29 patients who received RARP after a median period of 15.4 months of AS (range 3.0-18.8 months). Main reasons for deferred radical therapy were repeat biopsy risk reclassification (45%) and prostate-specific antigen progression (38%). The direct-RARP group included 363 patients treated after 3.3 months (range 0.1-45.5 months). RARP generally resulted in clinically relevant unfavourable changes on different QoL domains in both groups. Preoperatively the AS-RARP group showed more favourable scores on multiple QoL domains (physical functioning, p = 0.004; role functioning, p = 0.001; global health, p = 0.043; sexual activity, p = 0.001; sexual functioning, p = 0.029; IIEF-15, p = 0.042). Postoperatively, most of these more favourable scores in the AS-RARP group had changed to scores similar to the direct-RARP group, except for IIEF-15 (p = 0.027) and urinary symptoms (p = 0.001). When using a 12 month treatment delay threshold, a similar but less distinct effect was seen.
  
  
  CONCLUSIONS
  Patients with low-risk prostate cancer who choose AS have more favourable preoperative QoL scores than patients who primarily elect radical prostatectomy, but these groups show similar postoperative QoL scores.
authors: Department of Urology, University Medical Center Utrecht , Utrecht , The Netherlands.
authors: Roderick C N
authors: RC
authors: van den Bergh
authors: Willem
authors: W
authors: de Blok
authors: Erik
authors: E
authors: van Muilekom
authors: Corinne
authors: C
authors: Tillier
authors: Lionne D
authors: LD
authors: Venderbos
authors: Henk G
authors: HG
authors: van der Poel
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen
keywords: active surveillance; expectant management; prostate cancer; quality of life; radical prostatectomy