title: The ProCaSP study: quality of life outcomes of prostate cancer patients after radiotherapy or radical prostatectomy in a cohort study.
abstract: BACKGROUND
  This study describes and compares health-related quality of life (HRQOL) of prostate cancer patients who received either radical prostatectomy (nerve-sparing, nsRP, or non-nerve-sparing, nnsRP) or radiotherapy (external RT, brachytherapy, or both combined) for treatment of localised prostate cancer.
  
  
  METHODS
  The prospective, multicenter cohort study included 529 patients. Questionnaires included the IIEF, QLQ-C30, and PORPUS-P. Data were collected before (baseline), three, six, twelve, and twenty-four months after treatment. Differences between groups' baseline characteristics were assessed; changes over time were analysed with generalised estimating equations (GEE). Missing values were treated with multiple imputation. Further, scores at baseline and end of follow-up were compared to German reference data.
  
  
  RESULTS
  The typical time trend was a decrease of average HRQOL three months after treatment followed by (partial) recovery. RP patients experienced considerable impairment in sexual functioning. The covariate-adjusted GEE identified a significant - but not clinically relevant - treatment effect for diarrhoea (b = 7.0 for RT, p = 0.006) and PORPUS-P (b = 2.3 for nsRP, b = 2.2 for RT, p = 0.045) compared to the reference nnsRP. Most of the HRQOL scores were comparable to German norm values.
  
  
  CONCLUSIONS
  Findings from previous research were reproduced in a specific setting of a patient cohort in the German health care system. According to the principle of evidence-based medicine, this strengthens the messages regarding treatment in prostate cancer and its impacts on patients' health-related quality of life. After adjustment for baseline HRQOL and other covariates, RT patients reported increased symptoms of diarrhoea, and nnsRP patients decreased prostate-specific HRQOL. RP patients experienced considerable impairment in sexual functioning. These differences should be taken into account by physicians when choosing the best therapy for a patient.
authors.affiliation: Institute of Cancer Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany. nora.eisemann@uksh.de.
authors.forename: Nora
authors.initials: N
authors.lastname: Eisemann
authors.affiliation: Medical Clinic, Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. Sandra.Nolte@charite.de.|Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia. Sandra.Nolte@charite.de.
authors.forename: Sandra
authors.initials: S
authors.lastname: Nolte
authors.affiliation: Institute of Social Medicine and Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany. maike.schnoor@uksh.de.
authors.forename: Maike
authors.initials: M
authors.lastname: Schnoor
authors.affiliation: Institute of Cancer Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany. alexander.katalinic@uksh.de.|Institute of Social Medicine and Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany. alexander.katalinic@uksh.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Katalinic
authors.affiliation: Medical Practice of Urology, Auguststr. 4, 23611, Bad Schwartau, Germany. vrohde@gmx.de.|Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany. vrohde@gmx.de.
authors.forename: Volker
authors.initials: V
authors.lastname: Rohde
authors.affiliation: Institute of Social Medicine and Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany. annika.waldmann@uksh.de.
authors.forename: Annika
authors.initials: A
authors.lastname: Waldmann
mesh_terms: D000368:Aged; D001918:Brachytherapy; D003131:Combined Modality Therapy; D005858:Germany; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life; D011795:Surveys and Questionnaires