title: Health-related quality of life following radical prostatectomy: long-term outcomes.
abstract: OBJECTIVE
  To identify the health-related quality of life (HRQoL) domains that radical prostatectomy (RP) impacts most negatively and to define the recovery of these domains over 30 months of observation.
  
  
  METHODS
  A total of 1,200 RP patients completed the Patient-Oriented Prostate Utility Scale-Psychometric (PORPUS-P; range 0-100, higher is better), a prostate cancer-specific HRQoL measure, prior to RP and at 0-3 (T1), 3-9 (T2), 9-18 (T3) and 18-30 (T4) months post-RP. HRQoL changes were examined using paired t tests and a mixed-effect growth curve model. Multivariable analyses were performed to investigate demographic and treatment factors predicting the change in HRQoL.
  
  
  RESULTS
  Mean baseline PORPUS-P score, 83.1, fell to 66.5 (p < 0.001) at T1. Over time HRQoL improved but did not return to baseline (T4 mean 76.4, p < 0.001). Domain analysis revealed that sexual function (p < 0.001), sexual drive (p < 0.001), energy (p = 0.001) and bladder control (p < 0.001) failed to return to baseline at T4. Sexual function demonstrated the greatest impairment overall. The multivariable model revealed Black men experienced greater losses in global HRQoL compared with White men (coefficient -2.77, 95% CI -5.00 to -0.54, p = 0.015). High baseline HRQoL, pro-erectile aid use and bilateral nerve-sparing were significantly associated with smaller reductions in HRQoL post-RP.
  
  
  CONCLUSIONS
  Overall HRQoL, sexual drive, sexual function, energy and bladder control do not return to preoperative levels within 30 months post-RP. Black patients experience the greatest reductions in HRQoL. HRQoL losses may be ameliorated by use of pro-erectile aids. These findings help to identify at-risk patient populations and inform survivorship programs.
authors.affiliation: Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada, andrew.matthew@uhn.ca.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Matthew
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
authors.forename: Tal
authors.initials: T
authors.lastname: Davidson
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Currie
authors.forename: Haiyan
authors.initials: H
authors.lastname: Jiang
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
authors.forename: Neil E
authors.initials: NE
authors.lastname: Fleshner
authors.forename: Robin
authors.initials: R
authors.lastname: Kalnin
authors.forename: Alyssa S
authors.initials: AS
authors.lastname: Louis
authors.forename: B Joyce
authors.initials: BJ
authors.lastname: Davison
authors.forename: John
authors.initials: J
authors.lastname: Trachtenberg
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000601:surgery*; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012725:Sexual Behavior; D011795:Surveys and Questionnaires