title: Prospective quality-of-life outcomes for low-risk prostate cancer: Active surveillance versus radical prostatectomy.
abstract: BACKGROUND
  For patients with low-risk prostate cancer (PCa), active surveillance (AS) may produce oncologic outcomes comparable to those achieved with radical prostatectomy (RP). Health-related quality-of-life (HRQoL) outcomes are important to consider, yet few studies have examined HRQoL among patients with PCa who were managed with AS. In this study, the authors compared longitudinal HRQoL in a prospective, racially diverse, and contemporary cohort of patients who underwent RP or AS for low-risk PCa.
  
  
  METHODS
  Beginning in 2007, HRQoL data from validated questionnaires (the Expanded Prostate Cancer Index Composite and the 36-item RAND Medical Outcomes Study short-form survey) were collected by the Center for Prostate Disease Research in a multicenter national database. Patients aged ≤75 years who were diagnosed with low-risk PCa and elected RP or AS for initial disease management were followed for 3 years. Mean scores were estimated using generalized estimating equations adjusting for baseline HRQoL, demographic characteristics, and clinical patient characteristics.
  
  
  RESULTS
  Of the patients with low-risk PCa, 228 underwent RP, and 77 underwent AS. Multivariable analysis revealed that patients in the RP group had significantly worse sexual function, sexual bother, and urinary function at all time points compared with patients in the AS group. Differences in mental health between groups were below the threshold for clinical significance at 1 year.
  
  
  CONCLUSIONS
  In this study, no differences in mental health outcomes were observed, but urinary and sexual HRQoL were worse for patients who underwent RP compared with those who underwent AS for up to 3 years. These data offer support for the management of low-risk PCa with AS as a means for postponing the morbidity associated with RP without concomitant declines in mental health.
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason, Seattle, Washington.|University of Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.affiliation: Center for Prostate Disease Research, Department of Defense, Rockville, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cullen
authors.affiliation: Center for Prostate Disease Research, Department of Defense, Rockville, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Hurwitz
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason, Seattle, Washington.
authors.forename: Erika M
authors.initials: EM
authors.lastname: Wolff
authors.affiliation: Center for Prostate Disease Research, Department of Defense, Rockville, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Levie
authors.affiliation: Center for Biomedical Statistics, University of Washington, Seattle, Washington.
authors.forename: Katherine
authors.initials: K
authors.lastname: Odem-Davis
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason, Seattle, Washington.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Johnston
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason, Seattle, Washington.
authors.forename: Khanh N
authors.initials: KN
authors.lastname: Pham
authors.affiliation: Center for Prostate Disease Research, Department of Defense, Rockville, Maryland.|Urology Service, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Inger L
authors.initials: IL
authors.lastname: Rosner
authors.affiliation: Center for Prostate Disease Research, Department of Defense, Rockville, Maryland.|Department of Urology, Madigan Army Medical Center, Tacoma, Washington.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Brand
authors.affiliation: Center for Prostate Disease Research, Department of Defense, Rockville, Maryland.|Department of Urology, Naval Medical Center San Diego, San Diego, California.
authors.forename: James O
authors.initials: JO
authors.lastname: L'Esperance
authors.affiliation: Center for Prostate Disease Research, Department of Defense, Rockville, Maryland.|Department of Urology, Tripler Army Medical Center, Honolulu, Hawaii.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Sterbis
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason, Seattle, Washington.|Center for Prostate Disease Research, Department of Defense, Rockville, Maryland.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Porter
mesh_terms: D000368:Aged; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D057832:Watchful Waiting
keywords: active surveillance; prostate cancer; quality of life; radical prostatectomy; survivorship
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