title: Reduction of quality of life in prostate cancer patients: experience among 6200 men in the Nordic countries.
abstract: OBJECTIVE
  Although many studies have dealt with adverse effects (AEs) and quality of life (QoL) in prostate cancer (PCa) patients, the quantification of the patients' perspective on AE-related reduction in QoL has been less studied. This study describes the impact of self-reported local (erectile, bowel, urinary dysfunction) or systemic (mental distress, fatigue, virility loss) AEs on QoL reduction.
  
  
  METHODS
  Nordic PCa patients completed a questionnaire containing 84 multiple-choice questions. The main outcome variable of the survey was patient-reported PCa-induced QoL reduction, assessed by descriptive and regression analyses. The level of significance was p < 0.05.
  
  
  RESULTS
  Among 6200 patients, 39% described their QoL as reduced owing to the PCa trajectory: radical prostatectomy group (RPGroup): 42%, radiotherapy without hormones (RADGroup): 27%, hormones (HormGroup): 47% and no treatment (NoTrtGroup): 19%. Except for the NoTrtGroup, urinary leakage and fatigue doubled the risk of QoL reduction, while virility loss and erectile dysfunction tripled the risk. Significant intergroup differences emerged for the age-adjusted odds of QoL reduction: RPGroup (0.66), RADGroup (0.40), HormGroup (0.95) and NoTrtGroup (0.22).
  
  
  CONCLUSIONS
  After RP, RAD or hormone treatment of PCa, systemic AEs, in particular loss of virility, significantly reduce PCa patients' QoL similarly to or more than local AEs. The probability of reduced QoL is highest during hormone treatment and lowest in patients without anticancer therapy, and seems lower in patients treated with RAD without hormones than after RP. The treatment-related risk of reduced QoL due to systemic AEs should become a part of the pretreatment counselling of patients.
authors.affiliation: a National Advisory Unit on Late Effects after Cancer Treatment , Oslo University Hospital, The Norwegian Radium Hospital , Oslo , Norway ;
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fosså
authors.affiliation: b StatMind Statistical & Mathematical Modelling Innovation & Design AB , Lund , Sweden ;
authors.forename: Thomas
authors.initials: T
authors.lastname: Bengtsson
authors.affiliation: c Department of Urology , Aarhus University Hospital , Aarhus , Denmark ;
authors.forename: Michael
authors.initials: M
authors.lastname: Borre
authors.affiliation: d Department of Urology , SUS Malmö , Region Skåne, Malmö , Sweden ;
authors.forename: Göran
authors.initials: G
authors.lastname: Ahlgren
authors.affiliation: e Department of Urology , Helsinki University Hospital , Helsinki , Finland ;
authors.forename: Antti
authors.initials: A
authors.lastname: Rannikko
authors.affiliation: a National Advisory Unit on Late Effects after Cancer Treatment , Oslo University Hospital, The Norwegian Radium Hospital , Oslo , Norway ;|f Faculty of Medicine, University of Oslo , Oslo , Norway.
authors.forename: Alv A
authors.initials: AA
authors.lastname: Dahl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000628:therapy*; D011788:Quality of Life; D012537:Scandinavian and Nordic Countries; D057566:Self Report; D013812:Therapeutics / Q000009:adverse effects
keywords: Adverse effects; reduced quality of life; risk factors; treatment