Long-term follow-up after active surveillance or curative treatment: quality-of-life outcomes of men with low-risk prostate cancer

Quality of Life Research, Feb 2017

Purpose To compare long-term (4–10 years) quality of life (QoL) of men with low-risk prostate cancer (PCa) treated by different modalities and a reference group without PCa. Methods In this cross-sectional study, four groups were sent a one-time QoL-questionnaire; PCa patients (1) following the structured Prostate cancer Research International Active Surveillance protocol, (2) who underwent radical prostatectomy (RP) in the context of the European Randomized study of Screening for Prostate Cancer—section Rotterdam, (3) who underwent radiotherapy (RT) at an academic hospital in The Netherlands, and (4) an age-matched reference group of men without PCa. The QoL-questionnaire addressed prostate-specific health (EPIC), generic health (SF-12), and anxiety (STAI-6). Statistical significance (p ≤ 0.05) and clinical relevance (≥0.5 SD) of differences between groups were assessed. Results The AS, RP, RT, and reference group response rates amounted to 74% (122/165), 66% (70/106), 66% (221/335), and 75% (205/273), respectively. At a mean of 6.6 years of follow-up, active surveillance (AS)-men reported better urinary function [M = 93.0 (SD = 10.6) vs. 80.0 (SD = 19.1), p ≤ 0.001], less urinary incontinence [M = 90.0 (SD = 14.6) vs. 70.1 (SD = 28.8), p ≤ 0.001], and better sexual function [M = 40.9 (SD = 24.6) vs. 14.8 (17.7), p ≤ 0.001, clinically relevant] than RP-men. Compared to RT, AS-men reported better sexual function [M = 40.9 (SD = 24.6) vs. 25.8 (SD = 25.0), p = 0.069]. The four groups reported similarly low anxiety levels; the number of highly anxious men (STAI ≥ 44) ranged from 8 to 13%. For all QoL domains, men on AS and men without PCa reported very similar scores. Conclusions Prostate-specific function of AS-men was significantly better than that of RP-men. When comparing AS to RT, a borderline significant difference in sexual function was seen. Men who followed an AS strategy for a long-term period were not anxious and accepted it well, suggesting that AS may be a good treatment option for men with low-risk PCa.

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Long-term follow-up after active surveillance or curative treatment: quality-of-life outcomes of men with low-risk prostate cancer

Qual Life Res Long-term follow-up after active surveillance or curative treatment: quality-of-life outcomes of men with low-risk prostate cancer Lionne D. F. Venderbos 0 1 2 4 Shafak Aluwini 0 1 2 4 Monique J. Roobol 0 1 2 4 Leonard P. Bokhorst 0 1 2 4 Eric H. G. M. Oomens 0 1 2 4 Chris H. Bangma 0 1 2 4 Ida J. Korfage 0 1 2 4 0 Department of Radiology, Erasmus Medical Center , Rotterdam , The Netherlands 1 Department of Public Health, Erasmus Medical Center , Rotterdam , The Netherlands 2 Department of Urology, Erasmus University Medical Center , Room Na1710, P.O. Box 2040, 3000 CA Rotterdam , The Netherlands 3 Lionne D. F. Venderbos 4 Department of Urology, Amphia Hospital , Breda , The Netherlands Purpose To compare long-term (4-10 years) quality of life (QoL) of men with low-risk prostate cancer (PCa) treated by different modalities and a reference group without PCa. Methods In this cross-sectional study, four groups were sent a one-time QoL-questionnaire; PCa patients (1) following the structured Prostate cancer Research International Active Surveillance protocol, (2) who underwent radical prostatectomy (RP) in the context of the European Randomized study of Screening for Prostate Cancer-section Rotterdam, (3) who underwent radiotherapy (RT) at an academic hospital in The Netherlands, and (4) an agematched reference group of men without PCa. The QoLquestionnaire addressed prostate-specific health (EPIC), generic health (SF-12), and anxiety (STAI-6). Statistical significance (p≤ 0.05) and clinical relevance (≥0.5 SD) of differences between groups were assessed. Results The AS, RP, RT, and reference group response rates amounted to 74% (122/165), 66% (70/106), 66% (221/335), and 75% (205/273), respectively. At a mean of 6.6 years of follow-up, active surveillance (AS)-men reported better urinary function [M = 93.0 (SD = 10.6) vs. 80.0 (SD  =  19.1), p ≤ 0.001], less urinary incontinence [M = 90.0 (SD  =  14.6) vs. 70.1 (SD  =  28.8), p ≤ 0.001], and better sexual function [M = 40.9 (SD  =  24.6) vs. 14.8 (17.7), p ≤ 0.001, clinically relevant] than RP-men. Compared to RT, AS-men reported better sexual function [M = 40.9 (SD  =  24.6) vs. 25.8 (SD  =  25.0), p = 0.069]. The four groups reported similarly low anxiety levels; the number of highly anxious men (STAI ≥ 44) ranged from 8 to 13%. For all QoL domains, men on AS and men without PCa reported very similar scores. Conclusions Prostate-specific function of AS-men was significantly better than that of RP-men. When comparing AS to RT, a borderline significant difference in sexual function was seen. Men who followed an AS strategy for a long-term period were not anxious and accepted it well, suggesting that AS may be a good treatment option for men with low-risk PCa. Active surveillance; Quality of life; Patient reported outcome; Radical prostatectomy; Radiotherapy; Shared decision-making Introduction Men diagnosed with low-risk prostate cancer (PCa) generally have three therapy options: radical prostatectomy (RP), radiotherapy (RT), or active surveillance (AS). Curative therapies, like RP and RT, are associated with side-effects, such as incontinence and impotence, while AS is aimed at deferring such side-effects by opting for an initial monitoring strategy [ 1 ]. With AS initial curative therapy is delayed, or avoided, and replaced by regular follow-up visits using prostate-specific antigen (PSA), digital rectal examination (DRE), prostate biopsy, and—potentially—magnetic resonance imaging (MRI). Choosing AS, however, requires living with untreated cancer and coping with the possibility of missing the ‘window of curability’. AS is reported to be safe [ 2, 3 ]. In a 15-year time frame, among men that underwent AS in the Sunnybrook cohort, 2.8% developed metastases and 1.5% died of PCa; this mortality rate being consistent with that of favourable-risk patients managed with the initial curative therapy [4]. AS is now included in many guidelines as a treatment option for men diagnosed with low-risk PCa, and over the years, the number of men choosing AS has been rising [ 2, 3, 5–7 ]. The need to understand the effect of AS on well-being of men is becoming more apparent now. In a recent systematic review, Bellardita and colleagues concluded that, so far, no major perturbations in the healthrelated quality of life (QoL) and psychological well-being of men on AS were seen over a follow-up period of 9–36 months [ 8 ]. However, QoL research amongst men on AS is still scarce compared to RP and RT QoL research, and current AS studies show some methodological drawbacks like the infrequent use of comparator groups, the lack of an appropriate non-cancer control group, and the use of various QoL measures which hinders comparison of QoL across treatment groups [ 8–10 ]. Furthermore, long-term patient reported outcomes are scarce. We aim to fill this gap by assessing long-term, i.e. 4–10 year, QoL of men with low-risk PCa who were either treated with AS (...truncated)


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Lionne D. F. Venderbos, Shafak Aluwini, Monique J. Roobol, Leonard P. Bokhorst, Eric H. G. M. Oomens, Chris H. Bangma, Ida J. Korfage. Long-term follow-up after active surveillance or curative treatment: quality-of-life outcomes of men with low-risk prostate cancer, Quality of Life Research, 2017, pp. 1635-1645, Volume 26, Issue 6, DOI: 10.1007/s11136-017-1507-7