title: Effect of investigation intensity and treatment differences on prostate cancer survivor's physical symptoms, psychological well-being and health-related quality of life: a two country cross-sectional study.
abstract: To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations.
  
  
  
  PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI).
  
  
  
  A cross-sectional postal questionnaire was sent to PCa survivors 2-18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into 'late disease' (stage III/IV and any Gleason grade (GG) at diagnosis) and 'early disease' (stage I/II and GG 2-7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression.
  
  
  
  3348 men responded (RoI n=2567; NI n=781; reflecting population sizes, response rate 54%). RoI responders were younger; less often had comorbidities (45% vs 38%); were more likely to present asymptomatically (66%; 41%) or with early disease (56%; 35%); and less often currently used androgen deprivation therapy (ADT; 2%; 28%). Current prevalence of incontinence (16%) and impotence (56% early disease, 67% late disease) did not differ between RoI and NI. In early disease, only current bowel problems (RoI 12%; NI 21%) differed significantly in multivariate analysis. In late disease, NI men reported significantly higher levels of gynaecomastia (23% vs 9%) and hot flashes(41% vs 19%), but when ADT users were analysed separately, differences disappeared. For HRQoL, in multivariate analysis, only pain (early disease: RoI 11.1, NI 19.4) and financial difficulties (late disease: RoI 10.4, NI 7.9) differed significantly between countries. There were no significant between-country differences in DASS-21 or index ED-5D-5L score.
  
  
  
  Treatment side effects were commonly reported and increased PCa detection in RoI has left more men with these side effects. We recommended that men be offered a PSA test only after informed discussion.
authors.affiliation: N. Ireland Cancer Registry; Queen's University Belfast, Centre for Public Health, Belfast, N. Ireland.
authors.forename: Anna T
authors.initials: AT
authors.lastname: Gavin
authors.affiliation: N. Ireland Cancer Registry; Queen's University Belfast, Centre for Public Health, Belfast, N. Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Donnelly
authors.affiliation: N. Ireland Cancer Registry; Queen's University Belfast, Centre for Public Health, Belfast, N. Ireland.
authors.forename: Conan
authors.initials: C
authors.lastname: Donnelly
authors.affiliation: Department of Epidemiology and Public Health, School of Nursing and Midwifery, University College Cork, Cork, Ireland.
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Drummond
authors.affiliation: N. Ireland Cancer Registry; Queen's University Belfast, Centre for Public Health, Belfast, N. Ireland.
authors.forename: Eileen
authors.initials: E
authors.lastname: Morgan
authors.affiliation: Department of General Practice, Queen's University Belfast, Belfast, UK.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Gormley
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology; D000073116:Cancer Survivors / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D007172:Erectile Dysfunction / Q000453:epidemiology; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009660:Northern Ireland / Q000453:epidemiology; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology
keywords: PSA Testing; Patient Reported Outcomes; Prostate Cancer; Survivors