title: Patients' perceptions of the negative effects following different prostate cancer treatments and the impact on psychological well-being: a nationwide survey.
abstract: BACKGROUND
  Although the prognosis of localised prostate cancer is good, the negative effects of prostate cancer treatment often impair patient quality of life. A growing number of men experience these negative effects over a longer time because of the increased incidence of and prolonged survival in prostate cancer, and the ageing of the population. Only a few studies have investigated the adverse effects of different prostate cancer treatments using large population-based samples.
  
  
  METHODS
  We conducted a nationwide survey (n=1239) to collect detailed information regarding the negative effects (i.e., the occurrence, perceived level and perceived bother since the beginning of the treatment) of prostate cancer treatments: radical prostatectomy, external beam radiotherapy, brachytherapy, hormone therapy and surveillance. Furthermore, we measured patient satisfaction with the outcome of the treatment and their psychological well-being (i.e., psychological symptoms and satisfaction with life) 5 years after diagnosis. The negative effects between the treatments were compared, and the determinants of satisfaction and psychological well-being were investigated.
  
  
  RESULTS
  The negative effects of all types of active prostate cancer treatments were common and persistent (33-48% reported symptoms at 5 years) and showed the known differences between the treatments. Prostatectomy and the radiotherapies caused urinary leakage; radiotherapy also caused symptoms of urinary irritation; and external radiation also caused bowel dysfunction. Most symptoms were considered highly bothersome. Most respondents (81-93%) reported that their treatment negatively affected their sex lives; 70-92% reported sexual dysfunction; and 20-58% reported that their sex lives with their spouses had ended. Urinary symptoms were especially associated with poorer psychological outcomes. The perception of symptom level and bother had a greater effect on patient satisfaction and well-being than the symptoms per se.
  
  
  CONCLUSIONS
  Multiple and persistent negative effects follow active prostate cancer treatment, and these effects predict long-term patient satisfaction and psychological well-being. The harms and benefits associated with prostate cancer treatments should be considered when selecting whether and how to actively treat prostate cancer.
authors.affiliation: National Institute for Health and Welfare THL, Health Monitoring Unit, Helsinki FI00271, Finland.
authors.forename: Ulla-Sisko
authors.initials: US
authors.lastname: Lehto
authors.affiliation: National Institute for Health and Welfare THL, Health Monitoring Unit, Helsinki FI00271, Finland.|University of Helsinki, Division of Social Pharmacy; DRA Consulting Oy, Helsinki FI01510, Finland.
authors.forename: Heli
authors.initials: H
authors.lastname: Tenhola
authors.affiliation: University of Helsinki; Helsinki University Hospital, Department of Urology, Helsinki FI00029, Finland.
authors.forename: Kimmo
authors.initials: K
authors.lastname: Taari
authors.affiliation: National Institute for Health and Welfare THL, Health Monitoring Unit, Helsinki FI00271, Finland.
authors.forename: Arpo
authors.initials: A
authors.lastname: Aromaa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001918:Brachytherapy / Q000009:adverse effects*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D010465:Perception; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000628:therapy*; D014549:Urinary Incontinence / Q000209:etiology / Q000523:psychology*; D057832:Watchful Waiting